title: Successful use of the Molecular Adsorbent Recirculating System (MARS) in a patient with primary biliary cirrhosis (PBC) and treatment refractory pruritus.
abstract: Primary biliary cirrhosis (PBC) is a chronic cholestatic liver disease often associated with severe pruritus. Despite maximal medical management pruritus often persists and has a detrimental effect on quality of life. For patients that are refractory to all medical treatments, more invasive approaches have been tried. Recently, a new extracorporeal hemodiafiltration method, Molecular Adsorbent Recirculating System (MARS), has been described. Based on the hypothesis that hydrophobic, protein-bound metabolites play a major role in the development of liver failure, this device uses an albumin enriched dialysate to facilitate the removal of albumin bound toxins. AIM: To assess the safety and efficacy of a single MARS treatment on the pruritus score in a patient with PBC and treatment refractory pruritus. DESIGN/PATIENTS: A 61-year-old female patient with biopsy proven PBC, who had been accepted on our liver transplantation waiting list because of treatment refractory pruritus, was subjected to a single MARS treatment. RESULTS: At the end of a single 8 h MARS treatment session pruritus completely disappeared. Not unexpectedly, however, this effect was only short lived. Except for a slight hypercalcemia no adverse events were observed. CONCLUSION: A single MARS treatment very effectively improved pruritus. Long-term repetitive treatment, however, might be necessary to sustain its effectiveness.
authors.affiliation: Gastroenterology and Hepatology Unit, Department of Internal Medicine, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
authors.forename: Beat
authors.initials: B
authors.lastname: Mullhaupt
authors.forename: Gerd A.
authors.initials: GA
authors.lastname: Kullak-Ublick
authors.forename: Patrice M.
authors.initials: PM
authors.lastname: Ambühl
authors.forename: Reto
authors.initials: R
authors.lastname: Stocker
authors.forename: Eberhard L.
authors.initials: EL
authors.lastname: Renner