title: Treatment of refractory cholestatic pruritus with molecular adsorbent recirculating system (MARS).
abstract: 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.
  
  
  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.
  
  
  CONCLUSIONS
  MARS therapy is a promising, safe therapeutic option to treat refractory pruritus caused by cholestatic liver disorders.
authors.affiliation: Liver Transplant Unit, University Reina Sofía Hospital, Av. Menéndez Pidal, 14004 Córdoba, Spain.
authors.forename: J L
authors.initials: JL
authors.lastname: Montero
authors.forename: J C
authors.initials: JC
authors.lastname: Pozo
authors.forename: P
authors.initials: P
authors.lastname: Barrera
authors.forename: E
authors.initials: E
authors.lastname: Fraga
authors.forename: G
authors.initials: G
authors.lastname: Costán
authors.forename: J L
authors.initials: JL
authors.lastname: Domínguez
authors.forename: J
authors.initials: J
authors.lastname: Muntané
authors.forename: A
authors.initials: A
authors.lastname: Rodriguez-Ariza
authors.forename: M
authors.initials: M
authors.lastname: Pleguezuelo
authors.forename: S
authors.initials: S
authors.lastname: Rufián
authors.forename: P
authors.initials: P
authors.lastname: López-Cillero
authors.forename: M
authors.initials: M
authors.lastname: de la Mata
mesh_terms: D000328:Adult; D002779:Cholestasis / Q000628:therapy*; D005260:Female; D015312:Hemodialysis Solutions; D006801:Humans; D008107:Liver Diseases / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000628:therapy; D011537:Pruritus / Q000628:therapy*; D016060:Sorption Detoxification
chemical_list: D015312:Hemodialysis Solutions