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Treatment of refractory cholestatic pruritus with molecular adsorbent recirculating system (MARS)
J L Montero1, J C Pozo, P Barrera
1Liver Transplant Unit, University Reina Sofía Hospital, Av. Menéndez Pidal, 14004 Córdoba, Spain.
Unlabelled:
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.
Insights
Molecular adsorbent recirculating system (MARS) therapy offered relief for intractable pruritus in patients with cholestatic liver diseases. This safe treatment shows promise for managing severe itching when other therapies fail.
Area of Science:
- Hepatology
- Gastroenterology
- Nephrology
Background:
- Pruritus is a frequent and debilitating symptom in cholestatic liver diseases and liver graft dysfunction.
- Existing medical treatments for pruritus often lack sufficient efficacy.
- Molecular adsorbent recirculating system (MARS) is an emerging therapeutic possibility.
Purpose of the Study:
- To evaluate the effectiveness and safety of MARS therapy in managing intractable pruritus in patients with advanced liver conditions.
- To document the outcomes of MARS treatment in a small cohort of patients with severe cholestatic pruritus.
Main Methods:
- MARS treatment involved three 8-hour sessions.
- Patients included those with primary biliary cirrhosis/autoimmune hepatitis overlap, ductopenic allograft rejection, and posttransplant cholestatic HCV recurrence.
- Pruritus intensity was assessed before and after MARS therapy, with additional follow-up assessments.
Main Results:
- MARS therapy was generally well-tolerated by all patients.
- One patient experienced temporary relief, while another had partial, temporary relief and later received a liver transplant.
- Significant reduction in pruritus was observed in two patients, with one avoiding retransplantation.
Conclusions:
- MARS therapy presents a promising and safe option for treating refractory pruritus associated with cholestatic liver disorders.
- The system demonstrated efficacy in improving symptoms and potentially altering treatment pathways, such as avoiding retransplantation.
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