Methods of preventing bacterial sepsis and wound complications after liver transplantation.
Gurusamy K, Nagendran SM, et al.Update of Cochrane Database Syst Rev. 2008;(4) PMID: 18843724.Cochrane Database of Systematic Reviews 3: CD006660 2014.
Aims
To systematically review the evidence of the benefits and harms of the methods used to prevent bacterial sepsis and wound complications in liver transplant patients.
Interventions
Selective bowel decontamination versus inactive control, prebiotics, probiotics or, granulocyte-colony stimulating factor or selective bowel decontamination versus placebo or no treatment.
Participants
Patients undergoing liver transplantation.
Outcomes
The primary outcomes were infection, mortality, retransplantation, and quality of life during and after transplantation, serious adverse events. Secondary outcomes included intensive therapy unit stay, and total hospital stay.
Follow-up
N/A
CET Conclusions
The authors have examined a variety of methods of preventing infection in randomised controlled trials in liver transplant recipients. Seven trials with 640 participants were identified but all bar one were of poor quality and as a result the quality of evidence was low. There were 5 comparisons of 7 trials, ranging from selective bowel decontamination versus inactive control, probiotics versus prebiotics, G-CSF versus control. In terms of mortality, none of the pre-treatments appeared to offer any proven benefit in the reduction of bacterial infections and wound complications after liver transplantation. Indeed the authors suggest that selective bowel decontamination may even increase the rate of infection compared with prebiotics and probiotics. They suggest a need for further randomised clinical trials with a low risk of bias and we would concur with those conclusions.
Quality notes
This is a systematic review - quality assessment is not appropriate.
Trial registration
Not reported.