Therapy of Intractable Pruritus With MARS M. Acevedo Ribó, J.M. Moreno Planas, C. Sanz Moreno, E.E. Rubio González, E. Rubio González, E. Boullosa Graña, V. Sanchez-Turrión, D. Sanz Guajardo, and V. Cuervas-Mons ABSTRACT Introduction. Pruritus is the most disabling symptom in patients with cholestatic liver diseases. Many drug therapies have been used for the treatment of these diseases, with different outcomes. The molecular adsorbent recirculating system (MARS) has been used in the treatment of intractable pruritus in cholestatic syndromes. We report our experience with MARS in 3 patients with intractable pruritus on the waiting list: 2 liver transplant recipients and a patient with primary biliary cirrhosis. Patients and Results. Two middle-aged women and 1 middle-aged man, who were recipients of an orthotopic liver transplant for primary biliary cirrhosis, underwent three (n = 2) and two (n = 1) 6-hour sessions of MARS due to medically uncontrollable pruritus. All noted marked improvement of pruritus, with decreased bilirubin levels, but this improvement lasted only a few days in all cases. We observed no changes in transaminase or albumin levels, or prothrombin time. Complications included an episode of angina due to anemia caused by jugular catheter bleeding, and thrombocytopenia in all patients. Conclusions. MARS is an effective treatment for intractable pruritus in cholestatic liver diseases, although its beneficial effect is short. This extracorporeal liver device is safe, because most related adverse events are mild. P RURITUS is the most disabling symptom in patients with cholestatic liver diseases. Many drug therapies have been used for the treatment in these patients, with different outcomes. 1 In patients who do not respond to medical therapies, other methods have been tried. Extracorporeal liver devices have gained attention as a complementary approach for patients with liver diseases. The molecular adsorbent recirculating system (MARS) has been used in the treatment of acute decompensation of chronic liver disease, acute liver failure, liver failure after surgery or liver transplantation (OLT), and intractable pruritus in cholestatic syndromes. 2 We report our experi- ence with MARS in 3 patients with intractable pruritus on the waiting list: 2 liver transplant recipients and a patient with primary biliary cirrhosis. CASE REPORTS Case 1 A 44-year-old female recipient underwent OLT in 1989 to treat cryptogenic cirrhosis. She remained asymptomatic until 2003, when biopsy proved chronic rejection developed. She had severe hyper- bilirubinemia (36 mg/dL) and intractable pruritus (score, 10 of 10 on a pruritus scale). She underwent 2 cycles of 2 sessions of 6 hours a day over 10 days. At the end of the first treatment cycle, the pruritus score was 1 point. Ten days later, the pruritus score was again 10 of 10. At the end of the second cycle, she had level 5 pruritus, and bilirubin was 15.5 mg/dL, which remained stable until OLT 15 days later. As a complications, in the third session the patient had an episode of angina due to anemia caused by jugular catheter bleeding and thrombocytopenia. Case 2 A 45-year-old woman underwent OLT in 1998, because of mixed alcohol and hepatitis C virus (HCV) infection cirrhosis. Five years later she had allograft cirrhosis, Child-Pugh stage 10, due to recurrence of hepatitis C virus infection, with marked hyperbiliru- binemia (25.2 mg/dL) and intractable pruritus (score, 10 of 10). She underwent 3 consecutive 6-hour sessions with MARS. At the end of therapy the pruritus had decreased to 1 point, and bilirubin to 15.5 From the Department of Nephrology (M.A.R., C.S.M., E.R.G., D.S.G.), Liver Transplant Unit (J.M.M.P., E.E.R.G., E.B.G., V.S- T., V.C-M.), Hospital Puerta de Hierro, Madrid, Spain. Address reprint requests to Dr José Marı´a Moreno Planas, Unidad de Trasplante Hepático, Hospital Puerta de Hierro, San Martı´n de Porres 4, 28035 Madrid, Spain. E-mail: josemariamoren@mixmail.com 0041-1345/05/$–see front matter © 2005 by Elsevier Inc. All rights reserved. doi:10.1016/j.transproceed.2005.02.002 360 Park Avenue South, New York, NY 10010-1710 1480 Transplantation Proceedings, 37, 1480 –1481 (2005)