Therapy of intractable pruritus with MARS

Area of Science:

• Hepatology
• Gastroenterology
• Nephrology

Background:

• Pruritus is a debilitating symptom in cholestatic liver diseases, often resistant to conventional drug therapies.
• The Molecular Adsorbent Recirculating System (MARS) is an extracorporeal liver device explored for intractable pruritus.
• This study evaluates MARS efficacy in liver transplant recipients and primary biliary cirrhosis patients with severe itching.

Observation:

• Three patients (2 liver transplant recipients, 1 primary biliary cirrhosis) with medically uncontrollable pruritus underwent MARS therapy.
• Patients received two or three 6-hour MARS sessions.
• Marked improvement in pruritus and decreased bilirubin levels were observed post-treatment.

Findings:

• MARS provided temporary relief from intractable pruritus, with benefits lasting only a few days.
• No significant changes were noted in transaminase levels, albumin, or prothrombin time.
• Adverse events included anemia-induced angina and thrombocytopenia, generally mild.

Implications:

• MARS demonstrates effectiveness as a treatment for intractable pruritus in cholestatic liver conditions.
• The beneficial effects of MARS are transient, necessitating further research for sustained relief.
• MARS is considered a safe extracorporeal liver device for managing severe pruritus, with manageable side effects.