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• W2065064369 abstract "Introduction: Pruritus can be a debilitating consequence of chronic cholestatic liver disease and can severely compromise quality of life. Its effects on quality of life sometimes makes it an indication for liver transplantation, a procedure not without serious complications and life time need for medications. Several anti-pruritic treatments like ultra violet lights and acupuncture have shown to be of variable value. Molecular Absorbent Recirculating System (MARS®) is a modified dialysis system using an albumin containing dialysate that is recirculated and perfused online through charcoal and anion exchange columns. MARS® enables the selective removal of albumin bound molecules like bilirubin and other water soluble substances. The exact mechanism of cholestatic pruritus is not known but bile acids and histamine are assumed as causative agents. MARS® has been shown to effectively reduce metabolites such as bile acids and bilirubin that are increased in cholestasis and may alleviate pruritus. Our aim is to present our experience of MARS® for the treatment of intractable pruritus in children with chronic cholestatic liver disease. Methods: The medical records of 3 children (2 male, median age 3 [range 3 – 5] years) who received MARS® treatment between 2001 – 2003 were reviewed. Their diagnoses were Alagille Syndrome in 2 and familial progressive intrahepatic cholestasis type 1 in 1 (child 3). All 3 children were taking Ursodeoxycholic acid and rifampicin to try and alleviate the itch, 2 were also taking colestyramine and one child required naltrexone and vallergan. Results: MARS® was administered via vascatheters inserted under sedation in 2 but child 3 had such severe itching and irritability he required deeper sedation and assisted ventilation for the first 24 hours of MARS®. Child 1 required MARS® as part of palliative care and received 2 sessions 3 months apart each with 3 cycles. Serum bilirubin (SBR) reduced from 707 to 376 umol/l and from 635 to 189 umol/l. Child 2 and 3 received one 3cycle session. There were no changes in SBR (185 umol/l to 189 umol/l, and 13 umol/l to 10 umol/l respectively) but total bile acids decreased from 162 to 34 umol/l, and 198 to 64 umol/l. There was subjective improvement of itching in all patients. Child 1 is currently been assessed for internal biliary diversion, child 2 continued to have relief 6 months later and the significant improvement in MARS® therapy in child 3 lead us to perform more long-term treatment with internal biliary diversion. Conclusion: MARS® maybe an effective treatment for some children with intractable pruritus but further research is necessary to identify those who would benefit." @default.
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• W2065064369 date "2004-06-01" @default.
• W2065064369 modified "2023-10-18" @default.
• W2065064369 title "P0376* THE TREATMENT OF INTRACTABLE PRURITUS WITH MARS" @default.
• W2065064369 doi "https://doi.org/10.1097/00005176-200406001-00500" @default.
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