Intractable pruritus is one of the most common symptoms of chronic liver disease, especially experienced by patients with prolonged cholestasis. It can become the most distressing symptom in patients affected by chronic liver disease, causing a reduction in quality of life, interfering with daily activities and leading to sleep deprivation or contributing to psychological disturbances up to suicide ideation. Therefore non-responding to medical therapy pruritus is an indication for liver transplantation. MARS is an extracorporeal AHF support system method using albumin-enriched dyalisate to facilitate the removal of albumin-bound toxins. Veno-venous access (double-lumen catheter type) was used for blood supply. Intravenous heparin was used for blood anticoagulation for the maintenance of the extracorporeal circuit. Blood flow rate was 150250 mL/min, depending on the hemodynamic situation of the patient. Blood passed through an albumin non-permeable, high flux dialysis membrane. The clinical improvement was evaluated primarily through Child Pugh Score,MELD. In each patient, liver function (AST,GGT, total and direct bilirubin, coagulation, ammoniemia, albuminemia, serum bile acid), kidney function (creatinine, sodium, potassium, azotemia, diuresis/h), arterial pressure were evaluated before and after the treatment. Before each treatment patients underwent to abdominal ultrasound or CT scanner to exlude organic causes for the pruritus.