title: 'Out-patient' albumin dialysis for cholestatic patients with intractable pruritus.
abstract: BACKGROUND
  Intractable pruritus is a major problem for some patients with cholestasis. Albumin dialysis has been shown to ameliorate pruritus, but long-term outcome data are limited.
  
  
  OBJECTIVE
  To evaluate the safety and efficacy of 'out-patient' albumin dialysis using the molecular adsorbent recirculating system (MARS) in the treatment of intractable pruritus in cholestatic patients referred for liver transplantation for symptomatic relief.
  
  
  METHODS
  Fifteen patients who failed to respond to standard medical therapy to control pruritus were included. Three MARS (6 h) sessions were performed per admission, and were repeated, if necessary. The intensity and severity of itch was quantified using itch severity and visual analogue scales (ISS and VAS).
  
  
  RESULTS
  Molecular adsorbent recirculating system treatment was safe and associated with immediate and complete response in 11 patients; two patients had a partial response and two patients had no response. Thirty-four treatments were performed during a follow-up period of 15.7 months (3-46) with patients requiring a mean of two admissions (1-6). The mean VAS and ISS improved significantly (both P < 0.001) with improvement in the patient's perception of their quality of life. The duration of acceptable relief in responders was 3.3 months (range 2-5). No serious adverse events were recorded, but the platelet count and haemoglobin were reduced significantly.
  
  
  CONCLUSIONS
  Molecular adsorbent recirculating system therapy delivered in an 'out-patient' setting is safe and effective with a high degree of patient acceptability. Albumin dialysis can be considered a viable therapeutic option for patients with severe intractable pruritus, in whom, the only other effective treatment option is liver transplantation.
authors.affiliation: Liver Failure Group, UCL Hepatology, University College London Medical School, Royal Free Hospital, Rowland Hill Street, London, UK.
authors.forename: P
authors.initials: P
authors.lastname: Leckie
authors.forename: G
authors.initials: G
authors.lastname: Tritto
authors.forename: R
authors.initials: R
authors.lastname: Mookerjee
authors.forename: N
authors.initials: N
authors.lastname: Davies
authors.forename: D
authors.initials: D
authors.lastname: Jones
authors.forename: R
authors.initials: R
authors.lastname: Jalan
mesh_terms: D000328:Adult; D000368:Aged; D000418:Albumins / Q000627:therapeutic use*; D001647:Bile Acids and Salts / Q000097:blood; D002779:Cholestasis / Q000097:blood / Q000628:therapy*; D015314:Dialysis Solutions / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D010147:Pain Measurement; D010976:Platelet Count; D011537:Pruritus / Q000097:blood / Q000628:therapy*; D011788:Quality of Life; D006435:Renal Dialysis / Q000379:methods*; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000418:Albumins; D001647:Bile Acids and Salts; D015314:Dialysis Solutions