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P Komolmit

Publications and source records attributed to P Komolmit.

5 recordsLinked to original sources
PubMed1999

Pretransplant prediction of prognosis after liver transplantation in primary sclerosing cholangitis using a Cox regression model.

Liver transplantation remains the only treatment for patients with end-stage primary sclerosing cholangitis (PSC); however, selection criteria for the procedure and its timing remains uncertain. The aim of this study was to identify pretransplant variables associated with survival after transplantation and to devise a Cox regression model for prediction of post-transplant survival. We studied 118 patients transplanted for PSC at the Queen Elizabeth Hospital, Birmingham, UK, being followed for up to 91/4 years after the procedure. The association between pretransplant data and the post-transplant survival up to 1 year was studied using the logrank test (univariate analyses) and Cox multiple regression analysis. Univariate analyses showed the following variables to be associated with a decreased post-transplant survival: high serum creatinine, high serum bilirubin, biliary tree malignancy, previous upper abdominal surgery, hepatic encephalopathy, ascites, and Crohn's disease, whereas ulcerative colitis was associated with increased post-transplant survival (all P </=.05). The final multiple Cox regression model included the following significant variables: inflammatory bowel disease, ascites, previous upper abdominal surgery, serum creatinine, and biliary tree malignancy (all P <.03). Biliary tree malignancy could be omitted from the Cox model with only slight loss of information. The results were validated using the data of 30 independent PSC patients from another center. These results can improve selection of patients with PSC for liver transplantation. The developed prognostic model for transplantation can be used in parallel with previously published prognostic models for nontransplantation. The obtained prognostic estimates will provide additional information that is useful for optimal timing of liver transplantation in the individual patient.

Adult↗
PubMed1999

Tacrolimus in liver transplantation.

Tacrolimus has been in clinical use for ten years. It was launched in a hail of publicity following the successful treatment of cases with apparently irreversible rejection using conventional immunosuppressive therapies. Since that time, the overall experience with the drug has increased considerably. The purpose of this article is to review tacrolimus comprehensively, including evidence derived from major clinical trials, to enable the reader to become familiar with its clinical role, including a comparison with its main competitor, cyclosporin. Tacrolimus was discovered in 1984, it predominantly acts via inhibition of T-cell mediated immunity, and to a lesser extent B-cell humoral immunity. The agent was introduced into clinical medicine in 1989 and was soon shown to be a highly effective immunosuppressive agent, receiving approval in 1994 by the Food and Drug Administration (FDA) for primary immunosuppression in adult and paediatric liver transplantation. Tacrolimus has proved to be a major development in transplantation. Whilst the available data have been hindered to some extent by deficiencies of trial design in the major studies, there is still more comparative clinical data available for tacrolimus than for any of its predecessors. The overall balance of risk benefit is considered by many to be tipped in favour of tacrolimus; it is likely that with more long-term follow-up results becoming available in liver and other solid organ transplants, the benefits will appear clearer.

Journal Article↗
PubMed1996

Prevalence of hepatitis E virus infection in Thailand.

Hepatitis E, also known as epidemic, non-A, non-B hepatitis, is an acute, enteric, infectious disease. The disease is usually mild, except in pregnant women, who suffer a high fatality rate from fulminant hepatic failure. Information on the disease in Thailand is limited. The prevalence of antibodies to the aetiological agent, hepatitis E virus (HEV), was therefore studied, in various groups of subjects from several regions of this country, using commercial ELISA for anti-HEV IgG and IgM. The prevalence of anti-HEV IgG, which was 9%-22% in the adult subjects (blood donors, pregnant women, patients with acute hepatitis and cases seen during an outbreak of hepatitis), increased with age. It was relatively low in children and adolescents from Bangkok (3.6%) and in children from the north-east (1.8%-6.2%) and south (2.3%) of the country. Five (7%) of the 68 patients with acute viral hepatitis who were tested for anti-HEV IgM were found positive. Although these five cases had jaundice (four cases), diarrhoea (three) and/or dark urine (at least four cases), all of these clinical signs were self-limiting and had no sequelae. Given the apparently high prevalence of HEV infection in young adults in Thailand, control measures, including provision of clean water supplies and better personal sanitation and food hygiene, should be implemented to prevent an epidemic of the disease.

Adolescent↗
PubMed1996

Caffeine clearance by two point analysis: a measure of liver function in chronic liver disease.

This study attempted to compare the pharmacokinetic parameters of caffeine in patients with chronic liver disease and in normal subjects and to define the two sampling times which are suitable for determining caffeine clearance in these patients. Ten decompensated and eight compensated cirrhotic patients, and nine patients with chronic hepatitis were given a 3.5 mg/kg single oral dose of caffeine, followed by measurement of serum caffeine concentrations at 0, 30, 60, 90 minutes and 3, 5, 10, 24 and 36 hours using the HPLC technique. Caffeine clearance and its elimination rate constant in the decompensated cirrhotic patients were significantly lower than those in the compensated cirrhotic patients and much lower than in normal subjects (p > 0.01). Caffeine clearance in chronic hepatitis patients was also significantly lower than in normal subjects. The volumes of distribution of caffeine in compensated and decompensated cirrhotic patients and normal subjects were significantly different. There was also a significant difference between normal subjects and the chronic hepatitis group. Serum caffeine clearance showed a good correlation with Child Pugh's score at r = -0.788. Two sampling times within 10 to 24 hours after oral dose of caffeine served as the best sampling points for determination of caffeine clearance by the simple equation; Cl = kel approximately Vd (Vd is a fixed value in each group). It was clearly shown that caffeine clearance, calculated by two point analysis, would be a simple and useful method for measuring liver function in chronic liver disease.

Adult↗