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Therapy of intractable pruritus with MARS
M Acevedo Ribó1, J M Moreno Planas, C Sanz Moreno
1Department of Nephrology, Hospital Puerta de Hierro, Madrid, Spain.
Introduction:
Pruritus is the most disabling symptom in patients with cholestatic liver diseases. Many drug therapies have been used for the treatment of these diseases, with different outcomes. The molecular adsorbent recirculating system (MARS) has been used in the treatment of intractable pruritus in cholestatic syndromes. We report our experience with MARS in 3 patients with intractable pruritus on the waiting list: 2 liver transplant recipients and a patient with primary biliary cirrhosis.
Patients And Results:
Two middle-aged women and 1 middle-aged man, who were recipients of an orthotopic liver transplant for primary biliary cirrhosis, underwent three (n = 2) and two (n = 1) 6-hour sessions of MARS due to medically uncontrollable pruritus. All noted marked improvement of pruritus, with decreased bilirubin levels, but this improvement lasted only a few days in all cases. We observed no changes in transaminase or albumin levels, or prothrombin time. Complications included an episode of angina due to anemia caused by jugular catheter bleeding, and thrombocytopenia in all patients.
Conclusions:
MARS is an effective treatment for intractable pruritus in cholestatic liver diseases, although its beneficial effect is short. This extracorporeal liver device is safe, because most related adverse events are mild.
Insights
The Molecular Adsorbent Recirculating System (MARS) effectively alleviates intractable pruritus in cholestatic liver diseases. While temporary, this extracorporeal liver device offers a safe option for managing severe itching in liver patients.
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.
