Rifaximin reduces the incidence of spontaneous bacterial peritonitis, variceal bleeding and all‐cause admissions in patients on the liver transplant waiting list

Abstract

SummaryBackgroundRifaximin reduces the risk of overt hepatic encephalopathy (HE) and is associated with significant reductions in hospitalisations and 30‐day readmissions.AimTo examine the outcomes of patients listed for liver transplantation with a diagnosis of HE on rifaximin compared to those naïve to the drug.MethodsPatient records of those listed for liver transplantation over a 2‐year period were retrospectively reviewed. Patients were included if they had at least two episodes of overt HE resulting in hospitalisation or were encephalopathic at the time of assessment.ResultsOf the 622 patients listed for transplantation, 101 had HE. Sixty‐six patients were treated with rifaximin and 35 were naïve at listing. The use of concurrent lactulose was not significantly different between groups. Median MELD score was similar (15 [14‐16)] rifaximin‐treated and 16 [14‐18] rifaximin‐naïve). Patients on the waiting list treated with rifaximin had reduced all‐cause admissions, episodes of spontaneous bacterial peritonitis and variceal bleeding. Mean length of stay was 9 days (95% CI 6‐12) in the rifaximin‐treated group vs 14 (95% CI 7‐21) in the rifaximin‐naïve group. Multivariate regression analysis demonstrated that rifaximin was independently associated with an increase in average days to readmission (adjusted effect estimate 71, 95% CI 3‐140 days) and reduced likelihood of requirement for prioritisation on the waiting list (odds ratio 0.29; 95% CI 0.89‐0.93).ConclusionRifaximin prescribed for HE in patients listed for liver transplantation improved outcomes with significant reduction in admissions related to spontaneous bacterial peritonitis, ascites and variceal bleeding.

Palliative care in liver disease: what does good look like?

“…Encouraging patients and carers to adjust laxative and/or enema doses themselves may help improve QOL and avoid hospital admission 47. Recent studies examining the efficacy of rifaximin in clinical practice found, in combination with lactulose, it reduced both the frequency and length of hospital admissions51 52 confirming previous clinical trial findings 53. Thus in patients with advanced disease, early use of rifaximin should be encouraged 54…”

The Use of Rifaximin in Patients With Cirrhosis

“…Taking this into consideration, it is suggested that, by reducing serum levels of proinflammatory mediators linked to intestinal bacterial translocation, rifaximin may decrease portal hypertension, improve systemic hemodynamics (increasing systemic vascular resistances and mean arterial pressure) and renal function (improving glomerular filtration rate and urinary sodium excretion) (23)(24)(25)66,70) . Hence, valuable clinical benefits have been associated with rifaximin, including a reduction in the incidence of decompensation of cirrhosis, of all-cause Accepted Article hospitalizations and readmissions, of variceal bleeding, and of acute kidney injury (AKI), including hepatorenal syndrome (HRS), with a decreased risk of renal replacement therapy (58,64,65,(67)(68)(69)(70)(71)(72)(73)(74)(75)(76)(77)(78)(79)72) . A better control of difficult to treat/refractory ascites was also shown when rifaximin was added to treatment (70,71) .…”

Outcomes after hepatic encephalopathy in population‐based cohorts of patients with cirrhosis

“…In recent years there is increasing awareness of the benefits of nutritional support, 21,22 mounting data on the benefits of coordinated care with subspecialists 23 and novel pharmacotherapies for secondary prophylaxis of hepatic encephalopathy episodes 21 . Optimised therapy using combination lactulose and rifaximin may not only prevent episodes of hepatic encephalopathy but also could reduce overall mortality 24‐26 …”