Administration of Rifaximin to Improve Liver Regeneration and Outcome Following Major Liver Resection
Status:
Terminated
Trial end date:
2020-11-20
Target enrollment:
Participant gender:
Summary
Surgery is in almost all cases the only potentially curative treatment option for patients
with primary or secondary malignancies of the liver. However, in most cases oncological
resections ("R0-resections") can only be achieved by performing major liver resections (4 or
more liver segments), which is related to considerable postoperative complications such as
systemic infections and postoperative liver insufficiency (postresectional liver failure
(PRLF)). Despite optimized preoperative and postoperative strategies of care presently, up to
32-55% of patients display severs postoperative complications (Clavien score ≥ 3a) and 5%
even suffer from a severe PRLF. Recent observations in murine disease models as well as human
patients suggested that postoperative alterations of hemodynamics within the portal vein
tract as well as postoperative modulations of the immune response facilitates the
translocation of gut bacteria in the blood, leading to systemic infections and sepsis.
Moreover it became apparent that inflammatory mediators, released by the gut microbiota might
negatively affect postoperative liver regeneration. Rifaximin (Xifaxan®) is a novel and
potent, semisynthetic antibiotic that efficiently acts against most enteric bacteria and
significantly reduced liver inflammation and liver fibrosis in animal studies. Moreover,
Rifaximin is very well tolerated, even in patients with liver insufficiency.