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.
Highlights
The onset of advanced cirrhosis brings with it a catalogue of com‐ plications affecting multiple organ systems and includes hepatic encephalopathy (HE), variceal bleeding, ascites and a propensity to developing infections such as spontaneous bacterial peritonitis which can lead to the rapid onset of renal failure and metabolic dis‐ array
Multivariate linear regression analysis with days to readmission defined as the dependent variable demon‐ strated that rifaximin treatment was independently associated with increased length to all‐cause readmission whilst on the liver trans‐ plant waiting list; adjusted effect estimate 71 when adjusting for age, sex, Body Mass Index (BMI), disease severity score and con‐ comitant lactulose use
Binary logistic regression was performed to assess requirement for prioritisation (UKELD ≥63) on the liver transplant waiting list and demonstrated that rifaximin treatment was independently associated with a lower likelihood of requirement for prioritisation when adjusting for age, sex, BMI, disease severity score and con‐ comitant lactulose use
Summary
The onset of advanced cirrhosis brings with it a catalogue of com‐ plications affecting multiple organ systems and includes hepatic encephalopathy (HE), variceal bleeding, ascites and a propensity to developing infections such as spontaneous bacterial peritonitis which can lead to the rapid onset of renal failure and metabolic dis‐ array. Patients may progress to develop acute‐on‐chronic liver fail‐ ure (ACLF) and the associated morbidity and mortality is high. These patients require frequent hospitalisation[1] often necessitating high dependency or intensive care and present a significant healthcare and resource burden.[2] Without access to liver transplantation, the outlook is bleak.[3].
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