title: Charcoal hemoperfusion in the treatment of medically refractory pruritus in cholestatic liver disease.
abstract: BACKGROUND
  Pruritus is a distressing symptom in a considerable proportion of cholestatic patients and a few of them do not respond to conventional treatment. Charcoal hemoperfusion (CH) is an extracorporeal technique that is effective in eliminating protein-bound substances which may have accumulated during cholestasis. Several case reports have shown significant reduction of bilirubin in mechanical jaundice and neonatal hemolytic jaundice. However, the published data of CH for the treatment of refractory pruritus in cholestatic patients are scarce.
  
  
  METHODS
  Procedure code "Charcoal hemoperfusion" (90997) was used to identify patients who received CH at Mayo Clinic, Rochester, from 1 January 2000 to 5 January 2015. Patients who received CH for refractory cholestatic pruritus were retrospectively reviewed.
  
  
  RESULTS
  Thirteen patients were identified. A median of 5 (range 1-18) sessions for a total of 20 (1-72) h were performed. CH resulted in a significant decrease of pruritus in nine patients (69%). Two patients did not have significant relief and two patients did not pursue further treatments after having adverse reactions during the first session. Median pruritus numerical rating scale significantly decreased from 9/10 (9-10) to 4/10 (0-9) post-treatment (p = 0.004). Duration of symptom-free periods ranged from 8 to 90 days (median 18 days) in six patients who returned for follow-up. Most common adverse reactions were pain, bleeding from the catheter site and fever.
  
  
  CONCLUSIONS
  CH temporarily improves the severity of medically refractory cholestatic pruritus in some patients. However, the improvement is not sustained and the short duration of benefit should be balanced with the invasive nature of the therapy and the relatively common adverse reactions.
authors.affiliation: Division of Nephrology and Hypertension, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
authors.forename: Wonngarm
authors.initials: W
authors.lastname: Kittanamongkolchai
authors.affiliation: Division of Nephrology and Hypertension, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
authors.forename: Ziad M
authors.initials: ZM
authors.lastname: El-Zoghby
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
authors.forename: J
authors.initials: J
authors.lastname: Eileen Hay
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
authors.forename: Russell H
authors.initials: RH
authors.lastname: Wiesner
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
authors.forename: Patrick S
authors.initials: PS
authors.lastname: Kamath
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
authors.forename: Nicholas F
authors.initials: NF
authors.lastname: LaRusso
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
authors.forename: Kymberly D
authors.initials: KD
authors.lastname: Watt
authors.affiliation: Division of Nephrology and Hypertension, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
authors.forename: Carl H
authors.initials: CH
authors.lastname: Cramer
authors.affiliation: Division of Nephrology and Hypertension, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. Leung.nelson@mayo.edu.
authors.forename: Nelson
authors.initials: N
authors.lastname: Leung
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002779:Cholestasis / Q000150:complications* / Q000628:therapy; D006464:Hemoperfusion / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D011537:Pruritus / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Charcoal hemoperfusion; Cholestasis liver disease; Pruritus