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Background/Aim Hepatic encephalopathy (HE) is common among patients with liver cirrhosis with 30–40% of patients decompensating with overt HE during their clinical course. 1 The American Association for the Study of Liver Diseases (AASLD) makes a recommendation for IV L-ornithine L-Aspartate (LOLA) to be used as an alternative or additional agent to treat patients not responding to conventional therapy.2 There is limited UK data on the use of LOLA in clinical practice but mounting evidence suggests an additive benefit to LOLA with conventional treatment (Lactulose/Rifaximin) in improving outcomes in patients with severe HE.3 The aim of this study was to review and describe experience of LOLA in a large quaternary liver unit in the UK.Methods A retrospective review was conducted of all inpatients presenting between January 2024 and December 2024 with HE and chronic liver disease who received treatment with LOLA, identified from the electronic Pharmacy Dispensary database. Demographic and clinical data (MELD, Grade of HE, IV/PO LOLA, time to improvement in HE, length of stay (LOS) and readmission rates) was obtained from Clinical Portal/electronic patient record (EPR).Results 23 patients received LOLA, 20(87%) male, mean age 55 years (+/-11.3). Mean MELD and UKELD scores were 16(+/- 5.4) and 54.6(+/- 4.5) respectively. 12(52%) had underlying alcohol-related liver cirrhosis (ArLD), 3(17%) with metabolic dysfunction-associated steatotic liver disease (MASLD). LOLA was given IV to 12(52%) of patients, oral to 5(22%) with the remaining six patients receiving both IV and oral. 5(22%) had Grade IV HE on commencement, with 13(57%) having either Grade II or III HE. IV LOLA was continued for a median 6 days(IQR 5–8) oral for 7 days(IRQ 4.0–14.5). At day 3 following commencement, mean grade of HE was Grade I and GCS scoring improved by an average of 2 points with 12-point improvement observed in one case.Of the cohort, median IP stay was 32.5 (IQR 21.25–43.25) days. IP mortality was 3(13%). Of these, 2(66.7%) had death attributed to HE. Readmission rates at 30 days and 90 days were 5(21.7%) and 11(47.8%) respectively. 1 patient (4%) subsequently received a liver transplant.Discussion Our study describes the real-world practice of the use of LOLA in a quaternary liver centre. Although used infrequently there appears to be beneficial roles in patients with HE – its positioning in the armamentarium against HE remains to be secured but should be considered in a subset of patients with HE not responding to conventional treatment.Abstract P79 Table 1Previous HE 12 (92%) Previous admission with HE 11 (85%) Previous ITU admission with HE 1 (8%) Pre-admission TIPS 1 (8%) Pre-admission Rifaximin 12 (92%) Pre-admission Lactulose 11 (85%) Grade HE on presentation:IIIIIIIV 3 (23%)6 (46%)3 (23%)1 (8%) Ammonia level on admission med(IQR)*4 did not have levels checked 119 (59–155) Grade HE on day 3 of LOLA:0IIIIIIIV 16402 GCS on day 3 of LOLA (mean) 12.8 (+/-2.8) References Amodio P, Del Piccolo F, Pettenò E, Mapelli D, Angeli P, Iemmolo R, Muraca M, Musto C, Gerunda G, Rizzo C, Merkel C. Prevalence and prognostic value of quantified electroencephalogram (EEG) alterations in cirrhotic patients. Journal of hepatology. 2001 Jul 1;35(1):37–45.Vilstrup H, Amodio P, Bajaj J, Cordoba J, Ferenci P, Mullen KD, Weissenborn K, Wong P. Hepatic encephalopathy in chronic liver disease: 2014 practice guideline by the american association for the study of liver diseases and the european association for the study of the liver. Hepatology. 2014 Aug;60(2):715–35.Jain A, Sharma BC, Mahajan B, Srivastava S, Kumar A, Sachdeva S, Sonika U, Dalal A. L-ornithine L-aspartate in acute treatment of severe hepatic encephalopathy: a double-blind randomized controlled trial. Hepatology. 2022 May;75(5):1194–203.