BACKGROUND: Cholestatic pruritus may severely compromise quality of life. The Molecular Adsorbents Recirculating System (MARS) allows removal of pruritogenic substances without exposure to foreign proteins. Pediatric data, however, are scant. METHODS: We retrospectively analyzed the efficacy of MARS in three boys with severe cholestatic pruritus. They received a total of 135 MARS sessions during 8, 4, and 13 months prior to liver transplantation. Total serum bilirubin and bile acids were monitored, and pruritus was assessed by a numerical rating scale (NRS 0 = no pruritus, 10 = maximal pruritus). RESULTS: MARS sessions were initially performed three times weekly at a mean duration of 6.3 ± 1.4 h. Sessions could be reduced to once weekly and once every other week in two patients. Pre-MARS plasma bile acid concentrations averaged 207 ± 67 μmol/l. They declined to 67 ± 9%, 48 ± 3%, 38 ± 14%, and 37 ± 5% of baseline within 2, 4, 6 and 8 h of therapy, respectively (all p < 0.05). The average interdialytic increase of plasma bile acids was 34 ± 33 μmol/l per day. Mean NRS score decreased from 6.5 ± 2.3 to 3.3 ± 2.9 (p < 0.01). Skin lesions from itching disappeared. All MARS treatments were well tolerated. CONCLUSION: MARS dialysis substantially reduces cholestatic pruritus in children refractory to pharmacological treatment.
BACKGROUND:Cholestatic pruritus may severely compromise quality of life. The Molecular Adsorbents Recirculating System (MARS) allows removal of pruritogenic substances without exposure to foreign proteins. Pediatric data, however, are scant. METHODS: We retrospectively analyzed the efficacy of MARS in three boys with severe cholestatic pruritus. They received a total of 135 MARS sessions during 8, 4, and 13 months prior to liver transplantation. Total serum bilirubin and bile acids were monitored, and pruritus was assessed by a numerical rating scale (NRS 0 = no pruritus, 10 = maximal pruritus). RESULTS: MARS sessions were initially performed three times weekly at a mean duration of 6.3 ± 1.4 h. Sessions could be reduced to once weekly and once every other week in two patients. Pre-MARS plasma bile acid concentrations averaged 207 ± 67 μmol/l. They declined to 67 ± 9%, 48 ± 3%, 38 ± 14%, and 37 ± 5% of baseline within 2, 4, 6 and 8 h of therapy, respectively (all p < 0.05). The average interdialytic increase of plasma bile acids was 34 ± 33 μmol/l per day. Mean NRS score decreased from 6.5 ± 2.3 to 3.3 ± 2.9 (p < 0.01). Skin lesions from itching disappeared. All MARS treatments were well tolerated. CONCLUSION: MARS dialysis substantially reduces cholestatic pruritus in children refractory to pharmacological treatment.
Authors: P Geerdink; P Snel; G P van Berge Henegouwen; A Huybregts; A Tangerman; V A Kunst; J H van Tongeren Journal: Neth J Med Date: 1978 Impact factor: 1.422
Authors: A Régina; M Demeule; A Laplante; J Jodoin; C Dagenais; F Berthelet; A Moghrabi; R Béliveau Journal: Cancer Metastasis Rev Date: 2001 Impact factor: 9.264
Authors: Cataldo Doria; Lucio Mandalà; Jan D Smith; Giuseppe Caruana; Victor L Scott; Salvatore Gruttadauria; Mario Magnone; Ignazio R Marino Journal: Clin Transplant Date: 2004-08 Impact factor: 2.863
Authors: Romuald Bellmann; Clemens Feistritzer; Heinz Zoller; Ivo W Graziadei; Hubert Schwaighofer; Albert Propst; Christian J Wiedermann; Michael Joannidis Journal: ASAIO J Date: 2004 Jul-Aug Impact factor: 2.872
Authors: Peter Faybik; Andreas Bacher; Sibylle A Kozek-Langenecker; Heinz Steltzer; Claus Georg Krenn; Sandra Unger; Hubert Hetz Journal: Crit Care Date: 2006-02 Impact factor: 9.097
Authors: Lindsey L Kennedy; Laura A Hargrove; Allyson B Graf; Taylor C Francis; Kyle M Hodges; Quy P Nguyen; Yoshi Ueno; John F Greene; Fanyin Meng; Victoria D Huynh; Heather L Francis Journal: Lab Invest Date: 2014-11-03 Impact factor: 5.662
Authors: Faouzi Saliba; Rafael Bañares; Fin Stolze Larsen; Alexander Wilmer; Albert Parés; Steffen Mitzner; Jan Stange; Valentin Fuhrmann; Stefan Gilg; Tarek Hassanein; Didier Samuel; Josep Torner; Samir Jaber Journal: Intensive Care Med Date: 2022-09-06 Impact factor: 41.787