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1. Aliment Pharmacol Ther. 2012 Jan 20. doi: 10.1111/j.1365-2036.2012.04994.x. [Epub
ahead of print]

'Out-patient' albumin dialysis for cholestatic patients with intractable
pruritus.

Leckie P, Tritto G, Mookerjee R, Davies N, Jones D, Jalan R.

Liver Failure Group, UCL Hepatology, UCL Medical School, Royal Free Hospital, UK.

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. AIM: 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. CONCLUSION: 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.

© 2012 Blackwell Publishing Ltd.

PMID: 22260552 [PubMed - as supplied by publisher]