title: Effect of molecular adsorbent recirculating system in hepatitis C virus-related intractable pruritus.
abstract: Intractable pruritus is more common in cholestatic liver diseases and may be the presenting symptom and/or major complaint of hepatitis C and/or hepatitic C virus-related cirrhosis. From September 2000 to May 2002, three patients affected by intractable pruritus secondary to hepatitis C cirrhosis that failed medical treatment were treated with a molecular adsorbent recirculating system (MARS). MARS is an artificial liver support system that aims to clear the blood of metabolic waste products normally metabolized by the liver. Each patient underwent seven MARS sessions. Liver function tests, the 36-Item Short Form quality-of-life test, visual analog scale for itching, and bile acid measurement in the serum, albumin circuit and ultrafiltrate were performed before and after each MARS session. Moreover, at hospital admission, each patient underwent a psychological workup and abdominal imaging study. Subjective improvement in pruritus and quality of life, along with a decrease in serum bile acid concentration, was observed in every patient; no patient underwent retreatment and/or liver transplantation up to a 9-month follow-up. One patient died 201 days after MARS treatment. Although we observed a decreased level of serum bile acids, one cannot conclude that this was the mechanism of action for the reduction in pruritus intensity in patients in our series. Different toxins and/or a placebo effect might have had a role in this setting.
authors.affiliation: Department of Surgery, Thomas E. Starzl Transplantation Institute, University of Pittsburgh, and the National Liver Transplant Center of the Department of Veterans Affairs, PA 15213, USA. doriac@ismett.edu
authors.forename: Cataldo
authors.initials: C
authors.lastname: Doria
authors.forename: Lucio
authors.initials: L
authors.lastname: Mandalá
authors.forename: Jan
authors.initials: J
authors.lastname: Smith
authors.forename: Claudio H
authors.initials: CH
authors.lastname: Vitale
authors.forename: Augusto
authors.initials: A
authors.lastname: Lauro
authors.forename: Salvatore
authors.initials: S
authors.lastname: Gruttadauria
authors.forename: Ignazio R
authors.initials: IR
authors.lastname: Marino
authors.forename: Carlo Scotti
authors.initials: CS
authors.lastname: Foglieni
authors.forename: Mario
authors.initials: M
authors.lastname: Magnone
authors.forename: Victor L
authors.initials: VL
authors.lastname: Scott
mesh_terms: D000368:Aged; D001647:Bile Acids and Salts / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006526:Hepatitis C / Q000150:complications*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000821:virology*; D019164:Liver, Artificial; D008297:Male; D008875:Middle Aged; D009994:Osmolar Concentration; D011184:Postoperative Period; D011537:Pruritus / Q000209:etiology* / Q000601:surgery*; D011788:Quality of Life; D016896:Treatment Outcome
chemical_list: D001647:Bile Acids and Salts