title: Molecular Adsorbents Recirculating System dialysis in children with cholestatic pruritus.
abstract: BACKGROUND
  Cholestatic pruritus may severely compromise quality of life. The Molecular Adsorbents Recirculating System (MARS) allows removal of pruritogenic substances without exposure to foreign proteins. Pediatric data, however, are scant.
  
  
  METHODS
  We retrospectively analyzed the efficacy of MARS in three boys with severe cholestatic pruritus. They received a total of 135 MARS sessions during 8, 4, and 13 months prior to liver transplantation. Total serum bilirubin and bile acids were monitored, and pruritus was assessed by a numerical rating scale (NRS 0 = no pruritus, 10 = maximal pruritus).
  
  
  RESULTS
  MARS sessions were initially performed three times weekly at a mean duration of 6.3 ± 1.4 h. Sessions could be reduced to once weekly and once every other week in two patients. Pre-MARS plasma bile acid concentrations averaged 207 ± 67 μmol/l. They declined to 67 ± 9%, 48 ± 3%, 38 ± 14%, and 37 ± 5% of baseline within 2, 4, 6 and 8 h of therapy, respectively (all p < 0.05). The average interdialytic increase of plasma bile acids was 34 ± 33 μmol/l per day. Mean NRS score decreased from 6.5 ± 2.3 to 3.3 ± 2.9 (p < 0.01). Skin lesions from itching disappeared. All MARS treatments were well tolerated.
  
  
  CONCLUSIONS
  MARS dialysis substantially reduces cholestatic pruritus in children refractory to pharmacological treatment.
authors.affiliation: Center for Pediatric and Adolescent Medicine Heidelberg, University of Heidelberg, INF 430, 69120 Heidelberg, Germany.
authors.forename: Betti
authors.initials: B
authors.lastname: Schaefer
authors.forename: Franz
authors.initials: F
authors.lastname: Schaefer
authors.forename: Dieter
authors.initials: D
authors.lastname: Wittmer
authors.forename: Guido
authors.initials: G
authors.lastname: Engelmann
authors.forename: Daniel
authors.initials: D
authors.lastname: Wenning
authors.forename: Claus Peter
authors.initials: CP
authors.lastname: Schmitt
mesh_terms: D000293:Adolescent; D001647:Bile Acids and Salts / Q000097:blood; D001656:Biliary Atresia / Q000150:complications; D001663:Bilirubin / Q000097:blood; D002648:Child; D002779:Cholestasis / Q000150:complications* / Q000209:etiology / Q000628:therapy*; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D016030:Kidney Transplantation; D016031:Liver Transplantation; D008297:Male; D016720:Pneumocystis Infections / Q000150:complications; D045363:Pneumocystis carinii; D007690:Polycystic Kidney Diseases / Q000150:complications; D011537:Pruritus / Q000209:etiology* / Q000523:psychology / Q000628:therapy*; D011788:Quality of Life; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods*; D016060:Sorption Detoxification / Q000009:adverse effects / Q000379:methods*
chemical_list: D001647:Bile Acids and Salts; D001663:Bilirubin
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