Impact of rifaximin use for hepatic encephalopathy on the risk of early post‐transplant infections in liver transplant recipients

HY Sun, M Wagener, TV Cacciarelli… - Clinical …, 2012 - Wiley Online Library
HY Sun, M Wagener, TV Cacciarelli, N Singh
Clinical transplantation, 2012Wiley Online Library
Background Whether the use of rifaximin for hepatic encephalopathy during liver transplant
candidacy has an impact on post‐transplant infections is not known. Methods We compared
the frequency and spectrum of infections within 90 d post‐transplant in liver transplant
recipients who did and did not receive rifaximin for hepatic encephalopathy during
transplant candidacy. Results Of 110 consecutive liver transplant recipients, 30 (27%)
received rifaximin. Rifaximin users were more severely ill based on higher M odel for E nd‐S …
Background
Whether the use of rifaximin for hepatic encephalopathy during liver transplant candidacy has an impact on post‐transplant infections is not known.
Methods
We compared the frequency and spectrum of infections within 90 d post‐transplant in liver transplant recipients who did and did not receive rifaximin for hepatic encephalopathy during transplant candidacy.
Results
Of 110 consecutive liver transplant recipients, 30 (27%) received rifaximin. Rifaximin users were more severely ill based on higher Model for End‐Stage Liver Disease (MELD) score (p = 0.005). When controlled for MELD (stratified by MELD < 30, MELD ≥ 30), the risk of infections was significantly lower in rifaximin vs. no rifaximin recipients (OR = 0.269, 95% CI 0.078–0.0.934, p = 0.026). Rifaximin use was not associated with a higher risk of multidrug resistant bacterial infections (OR = 1.8, 95% CI 0.42–8.35, p = 0.40). The probability of post‐transplant survival at 90 d did not differ for patients with or without rifaximin use (0.90 for both groups, p = 0.56).
Conclusions
Rifaximin appeared to have a protective effect against early post‐transplant infections in more severely ill liver transplant recipients. Rifaximin use did not select for multidrug resistant bacteria in these patients.
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