Administration of Rifaximin to Improve Liver Regeneration and Outcome Following Major Liver Resection (ARROW)

RWTH Aachen University

Status and phase: Terminated; Phase 2

Conditions: Major Liver Resection; Malignant Liver Disease

Treatments: Drug: XIFAXAN® (Rifaximin)

Study type: Interventional

Funder types: Other

Identifiers

NCT02555293

CTC-A 13-129

Details and patient eligibility

About

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.

Enrollment: 96 estimated patients

Sex: All

Ages: 18 to 80 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

1. Patients undergoing a liver resection of at least 4 segments
2. Age > 18 years < 80 years
3. BMI 18-40
4. Patients with ASA (American Society of Anesthesiologists) I-III
5. Written informed consent prior to study participation

Exclusion criteria

1. Patients with ASA IV-V
2. Contraindication for MRI (see 5.4.3)
3. Underlying chronic liver disease such as severe fibrosis or liver cirrhosis
4. Need for procedures additive to partial liver resection
5. Participation in other liver related trials
6. BMI > 40
7. Previous liver transplantation or porto-systemic shunt
8. Concomitant acute infectious diseases
9. Renal insufficiency
10. Hypersensitivity to Rifaximin
11. Concomitant HIPEC (hypertherme intraperitoneale chemoperfusion) treatment
12. ALPPS (associating liver partition and portal vein ligation for staged hepatectomy)
13. Pregnant females as determined by positive [serum or urine] hCG (human chorionic gonadotropin) test at Screening or prior to dosing. Participants of child-bearing age should use adequate contraception as defined in the study protocol.
14. Lactating females
15. The subject has a history of any other illness, which, in the opinion of the investigator, might pose an unacceptable risk by administering study medication.
16. The subject received an investigational drug within 30 days prior to inclusion into this study
17. The subject has any current or past medical condition and/or required medication to treat a condition that could affect the evaluation of the study
18. The subject is unwilling or unable to follow the procedures outlined in the protocol
19. The subject is mentally or legally incapacitated

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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96 participants in 2 patient groups

film-coated Rifaximin (550 mg)

Experimental group

Description:

(550 mg) tablet twice daily for at least 14 days but up to 28 days dependent on the need for a PVE and the period between PVE (portal vein embolization) or randomization and surgery. Preoperative Rifaximin treatment in case of a PVE will start the day after PVE and will last for 14-21 days. In case patients are not pre-treated with a PVE they will receive Rifaximin for 7-10 days prior to surgery. Regardless of PVE, patients will receive additional Rifaximin treatment the first 7 days postoperatively.

Treatment:

Drug: XIFAXAN® (Rifaximin)

standard therapy

No Intervention group

Description:

Patients directed to the control group will not receive Rifaximin.