title: Treatment of refractory cholestatic pruritus after liver transplantation with albumin dialysis.
abstract: Albumin dialysis has been shown to improve the outcome in patients with cholestatic liver failure caused by chronic liver disease. This study reports 7 liver transplant recipients who were treated with albumin dialysis for intractable pruritus of different origin (ductopenic graft rejection, non-anastomotic strictures, and recurrence of hepatitis C). Treatment with histamine (H1) blockers, opioid antagonists, and cholestyramine had not been effective. The Molecular Adsorbent Recirculating System (MARS; Teraklin, Rostock, Germany) was used for albumin dialysis. All patients presented with numerous scratch marks, 6 of whom had a pronounced icterus. Six patients (86%) responded to 3 consecutive treatments with significant reduction of pruritus. The mean pruritus score, which was quantified by a visual analog scale (VAS), decreased from 9.7 +/- 0.5 to 3.7 +/- 0.8 (SD). The mean duration of 1 treatment was 15.6 hours. The procedure was well tolerated by all patients. The mean total serum bilirubin in patients who responded to therapy declined from 19.11 +/- 16.96 mg/dL (SD) before MARS therapy to 9.24 +/- 3.52 mg/dL after treatment. The mean serum concentration of 3 alpha-hydroxy bile acids decreased from 192.67 +/- 58.12 micromol/L (SD) to 42.33 +/- 31.58 micromol/L (SD). Follow-up in 3 cases showed sustained improvement of pruritus lasting for more than 3 months. In 3 patients, however, pruritus relapsed. One patient, who showed severe pruritus, without relevant elevation of serum bile acids before treatment, did not respond to albumin dialysis. Our data indicate that MARS is an effective therapeutic option for patients with intractable cholestatic pruritus.
authors.affiliation: Division of General Internal Medicine, Department of Internal Medicine, University of Innsbruck, Austria.
authors.forename: Romuald
authors.initials: R
authors.lastname: Bellmann
authors.forename: Ivo W
authors.initials: IW
authors.lastname: Graziadei
authors.forename: Clemens
authors.initials: C
authors.lastname: Feistritzer
authors.forename: Hubert
authors.initials: H
authors.lastname: Schwaighofer
authors.forename: Frans
authors.initials: F
authors.lastname: Stellaard
authors.forename: Ekkehard
authors.initials: E
authors.lastname: Sturm
authors.forename: Christian J
authors.initials: CJ
authors.lastname: Wiedermann
authors.forename: Michael
authors.initials: M
authors.lastname: Joannidis
mesh_terms: D000368:Aged; D000418:Albumins; D001647:Bile Acids and Salts / Q000097:blood; D001663:Bilirubin / Q000097:blood; D002779:Cholestasis / Q000150:complications*; D005260:Female; D015312:Hemodialysis Solutions; D006801:Humans; D008099:Liver / Q000201:enzymology; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008567:Membranes, Artificial; D008875:Middle Aged; D011537:Pruritus / Q000209:etiology / Q000628:therapy*; D012008:Recurrence; D006435:Renal Dialysis / Q000379:methods*
chemical_list: D000418:Albumins; D001647:Bile Acids and Salts; D015312:Hemodialysis Solutions; D008567:Membranes, Artificial; D001663:Bilirubin