*Purpose: Evaluate efficacy and safety of a probiotic preparation to reduce perioperative infection in patients undergoing liver transplant surgery

*Methods: Adult patients receiving liver transplantation from 5/7/2019- 9/30/2019 received a probiotic preparation of lactobacillus + guar gum prebiotic fibers given perioperatively for 14 days (POD 0- POD 14). These patients were compared to a standard of care (SOC) cohort who received liver transplant in the year prior to implementation of the protocol (3/1/2018-3/1/2019). In a power analysis using the 7% and 35% infectious incidence from prior literature, at least 33 subjects per group were needed to have at least 80% power for finding a significant difference in 30-day infection rates using a test of proportions. All patients received perioperative surgical prophylaxis and standard transplant infection prophylaxis per institutional protocol. Primary objective was incidence of perioperative bacterial infection. Secondary objectives were safety/toxicity as measured by lactobacillus-associated infectious events and one year rates of rejection, graft and patient survival

*Results: 144 patients met inclusion criteria; 33 in the probiotic cohort, 111 in the SOC cohort. Clinical characteristics were similar in the two groups (Table 1). Patients who received the probiotic preparation had a similar incidence of perioperative infective events (probiotic 13.4% vs SOC 14.5%, p=0.82). There were no lactobacillus-associated infectious events in the probiotic cohort (probiotic 0% vs SOC 1.8%, p>0.99). Rates of rejection, graft and patient survival were not different between groups (Table 2).

*Conclusions: An early interim analysis of the probiotic protocol suggests safety based on lack of lactobacillus-associated infections in the probiotic group. While rates of bacterial infection were not different, it is possible our sample size was not adequate to detect a more modest difference in infection rates. Ongoing evaluation of the benefits of perioperative probiotics in the current era of liver transplantation is warranted.

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