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Liver function defect in stable renal transplant patients
PC-15
A RANDf~SEDCONTROLLED DOUBLE-BLIND TRIAL OF LACTITOL AND LACTULOSE IN ACUTE HEPATIC ENCEPHALOPATHY IN CIRRHOTIC PATIENTS Katherine E Hawley, Marsha Y Morgan, Academic Department of Medicine, Royal Free Hospital, LONDON NW3 2QG
Lactitol (~-galactosido-sorbitol) is a nonabsorbable disaccharide available as a powder which, in open comparison, is as effective as lactulose in the treatment of chronic hepatic encephalopathy, but is better tolerated. Twenty-five cirrhotic patients needing treatment for 28 episodes of acute hepatic encephalopathy were blindly randomised to either lactitol (N=I5) or lactulose (N=13). The drugs were dispensed in solutions identical in colour, taste, pH and osmolerity which contained either 75g/100ml lactitol or 50.6g/100ml lactulose. The initial dose w~s 0.75mi/ kg and was adjusted to produce two semi-soft stools per day. Patients were assessed 12 hourly for five days. There were no significant differences in sex ratio, age, body weight, clinical status, duration and extent of coma, aetiology of liver disease or of hepatic encephalopathybetween the groups on entry to the trial. During the trial significant i~provements occurred in clinical and psychometric performance and in the electroencephalograms in the majority of patients in both groups. At the end of the trial 67% of the patients in the lactitol and 69% of the lactulose group were clinically normal. However, at 24 hours 33.0% of lactitol patients but only 8.2% of lactulose patients had improved significantly (p<0.05). An adequate catharsis was obtained with a daily equivalent dose of 31g lactitol (18.9-45) or 35mi (27-45) of commercial lactulose syrup. Six patients on lactitol (40%) and 4 patients on lactulose (27%) passed more than 4 stools/day. Both drugs are effective in the treatment of hepatic encephalopathy in cirrhotic patients, but patients treated with lactitol respond more quickly.
PC-16
LIVER FUNCTION DEFECT IN STABLE RENAL TRANSPLANTPATIENTS H.J. Schaad, F.J. Frey,* E. Renner, R. Preisi 9, Department of C l i n i c a l Pharmacology and Medical P o l i c l i n i c A, University of Berne, Berne, Switzerland
Liver f a i l u r e accounts for 2,5% of deaths in patients on hemodialysis and f o r 8,6% in patients with a functioning renal transplant (Report of Europ Dial and Transpl Assoc, 1983). In order to define the magnitude of the impairment of l i v e r function in patients a f t e r successful transplantation we measured galactose e l i m i n a t i o n capacity (GEC, 0.5g galactose/kg bw. i v . ) and caffeine plasma clearance (CPC,125mg caffeine i v . ) in a group of 40 consecutive stable kidney transplant (KT) patients on cyclosporine and prednisone maintenance therapy 1 month a f t e r operation. The group was made up of 21 males and 19 females ranging in age from 23-69 years (mean:46 years); three were HBsAG p o s i t i v e and in 5 ALAT was s l i g h t l y (<3x upper l i m i t ) increased. Their results were compared with 22 age and sexmatched controls. GEC values in the e n t i r e KT group was with 6.4 + S . D . l . l m g min- I kg-I s i g n i f i c a n t l y (p
$86
A RANDf~SEDCONTROLLED DOUBLE-BLIND TRIAL OF LACTITOL AND LACTULOSE IN ACUTE HEPATIC ENCEPHALOPATHY IN CIRRHOTIC PATIENTS Katherine E Hawley, Marsha Y Morgan, Academic Department of Medicine, Royal Free Hospital, LONDON NW3 2QG
Lactitol (~-galactosido-sorbitol) is a nonabsorbable disaccharide available as a powder which, in open comparison, is as effective as lactulose in the treatment of chronic hepatic encephalopathy, but is better tolerated. Twenty-five cirrhotic patients needing treatment for 28 episodes of acute hepatic encephalopathy were blindly randomised to either lactitol (N=I5) or lactulose (N=13). The drugs were dispensed in solutions identical in colour, taste, pH and osmolerity which contained either 75g/100ml lactitol or 50.6g/100ml lactulose. The initial dose w~s 0.75mi/ kg and was adjusted to produce two semi-soft stools per day. Patients were assessed 12 hourly for five days. There were no significant differences in sex ratio, age, body weight, clinical status, duration and extent of coma, aetiology of liver disease or of hepatic encephalopathybetween the groups on entry to the trial. During the trial significant i~provements occurred in clinical and psychometric performance and in the electroencephalograms in the majority of patients in both groups. At the end of the trial 67% of the patients in the lactitol and 69% of the lactulose group were clinically normal. However, at 24 hours 33.0% of lactitol patients but only 8.2% of lactulose patients had improved significantly (p<0.05). An adequate catharsis was obtained with a daily equivalent dose of 31g lactitol (18.9-45) or 35mi (27-45) of commercial lactulose syrup. Six patients on lactitol (40%) and 4 patients on lactulose (27%) passed more than 4 stools/day. Both drugs are effective in the treatment of hepatic encephalopathy in cirrhotic patients, but patients treated with lactitol respond more quickly.
PC-16
LIVER FUNCTION DEFECT IN STABLE RENAL TRANSPLANTPATIENTS H.J. Schaad, F.J. Frey,* E. Renner, R. Preisi 9, Department of C l i n i c a l Pharmacology and Medical P o l i c l i n i c A, University of Berne, Berne, Switzerland
Liver f a i l u r e accounts for 2,5% of deaths in patients on hemodialysis and f o r 8,6% in patients with a functioning renal transplant (Report of Europ Dial and Transpl Assoc, 1983). In order to define the magnitude of the impairment of l i v e r function in patients a f t e r successful transplantation we measured galactose e l i m i n a t i o n capacity (GEC, 0.5g galactose/kg bw. i v . ) and caffeine plasma clearance (CPC,125mg caffeine i v . ) in a group of 40 consecutive stable kidney transplant (KT) patients on cyclosporine and prednisone maintenance therapy 1 month a f t e r operation. The group was made up of 21 males and 19 females ranging in age from 23-69 years (mean:46 years); three were HBsAG p o s i t i v e and in 5 ALAT was s l i g h t l y (<3x upper l i m i t ) increased. Their results were compared with 22 age and sexmatched controls. GEC values in the e n t i r e KT group was with 6.4 + S . D . l . l m g min- I kg-I s i g n i f i c a n t l y (p
$86