Effect of molecular adsorbent recirculating system in hepatitis C virus-related intractable pruritus

Authors

  • Cataldo Doria,

    Corresponding author
    1. Department of Surgery, Thomas E. Starzl Transplantation Institute, University of Pittsburgh, and the National Liver Transplant Center of the Department of Veterans Affairs, Pittsburgh, PA; Palermo, Italy
    2. Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione IsMeTT—University of Pittsburgh Medical Center, Palermo, Italy
    • University of Pittsburgh, Thomas E. Starzl Transplantation Institute, 200 Lothrop St, Ste 10097, Forbes Tower, Pittsburgh, PA 15213. Telephone: 412-647-3904; Fax: 412-647-3222
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  • Lucio Mandalá,

    1. Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione IsMeTT—University of Pittsburgh Medical Center, Palermo, Italy
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  • Jan Smith,

    1. Department of Anesthesiology and Critical Care Medicine,Palermo, Italy
    2. Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione IsMeTT—University of Pittsburgh Medical Center, Palermo, Italy
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  • Claudio H. Vitale,

    1. Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione IsMeTT—University of Pittsburgh Medical Center, Palermo, Italy
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  • Augusto Lauro,

    1. Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione IsMeTT—University of Pittsburgh Medical Center, Palermo, Italy
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  • Salvatore Gruttadauria,

    1. Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione IsMeTT—University of Pittsburgh Medical Center, Palermo, Italy
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  • Ignazio R. Marino,

    1. Department of Surgery, Thomas E. Starzl Transplantation Institute, University of Pittsburgh, and the National Liver Transplant Center of the Department of Veterans Affairs, Pittsburgh, PA; Palermo, Italy
    2. Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione IsMeTT—University of Pittsburgh Medical Center, Palermo, Italy
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  • Carlo Scotti Foglieni,

    1. Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione IsMeTT—University of Pittsburgh Medical Center, Palermo, Italy
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  • Mario Magnone,

    1. Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione IsMeTT—University of Pittsburgh Medical Center, Palermo, Italy
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  • Victor L. Scott

    1. Department of Surgery, Thomas E. Starzl Transplantation Institute, University of Pittsburgh, and the National Liver Transplant Center of the Department of Veterans Affairs, Pittsburgh, PA; Palermo, Italy
    2. Department of Anesthesiology and Critical Care Medicine,Palermo, Italy
    3. Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione IsMeTT—University of Pittsburgh Medical Center, Palermo, Italy
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Abstract

Intractable pruritus is more common in cholestatic liver diseases and may be the presenting symptom and/or major complaint of hepatitis C and/or hepatitic C virus—related cirrhosis. From September 2000 to May 2002, three patients affected by intractable pruritus secondary to hepatitis C cirrhosis that failed medical treatment were treated with a molecular adsorbent recirculating system (MARS). MARS is an artificial liver support system that aims to clear the blood of metabolic waste products normally metabolized by the liver. Each patient underwent seven MARS sessions. Liver function tests, the 36-Item Short Form quality-of-life test, visual analog scale for itching, and bile acid measurement in the serum, albumin circuit and ultrafiltrate were performed before and after each MARS session. Moreover, at hospital admission, each patient underwent a psychological workup and abdominal imaging study. Subjective improvement in pruritus and quality of life, along with a decrease in serum bile acid concentration, was observed in every patient; no patient underwent retreatment and/or liver transplantation up to a 9-month follow-up. One patient died 201 days after MARS treatment. Although we observed a decreased level of serum bile acids, one cannot conclude that this was the mechanism of action for the reduction in pruritus intensity in patients in our series. Different toxins and/or a placebo effect might have had a role in this setting

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