Treatment of refractory cholestatic pruritus with molecular adsorbent recirculating system (MARS).

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Transplant Proc. 2006 Oct;38(8):2511-3.

Treatment of refractory cholestatic pruritus with molecular adsorbent recirculating system (MARS).

Montero JL, Pozo JC, Barrera P, Fraga E, Costan G, Dominguez JL, Muntane J, -Ariza A,

Pleguezuelo M, Rufian S, -Cillero P,

de la Mata M.

Liver Transplant Unit, Cordoba, Spain.

Pruritus is a common complication of cholestatic liver

diseases or liver graft dysfunction. Current medical

therapies lack efficacy. The molecular adsorbent recirculating system (MARS) represents an interesting

therapeutic option. Our objective was to report our

experience in the management of four patients with intractable pruritus with

MARS. PATIENTS AND METHODS: The MARS treatment cycle

included three consecutive treatments, each of 8 hours duration. The four patients with intractable pruritus who were

treated had primary biliary cirrhosis/autoimmune hepatitis overlap syndrome (n

= 1), ductopenic allograft rejection (n = 2), or posttransplant cholestatic HCV

recurrence (n = 1). Intensity of pruritus was

documented 24 hours before as well as 24 hours, 7 and 30 days after MARS

therapy, and at the end of follow-up. We measured

complete blood cell counts, glucose, BUN, creatinine,

sodium, potassium, AST, ALT, GGT, alkaline phosphatase,

bilirubin, prothrombin

activity, and activated partial thromboplastin time. RESULTS: MARS therapy was well tolerated.

Patient 1 experienced temporal relief of pruritus, but needed another

MARS cycle because of relapse. Patient 2 experienced

partial and temporary relief of pruritus, was listed for retransplantation,

and received a liver graft 2 months later. Patient 3

showed a dramatic reduction in the degree of pruritus with MARS. Pruritus in patient 4 decreased promptly with MARS therapy

and conversion of immunosuppression to tacrolimus, thereby avoiding retransplantation. CONCLUSION: MARS

therapy is a promising, safe therapeutic option to treat refractory pruritus

caused by cholestatic liver disorders.

PMID: 17097984 [PubMed - indexed

for MEDLINE]