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

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.