Treatment Of Intractable Pruritus Research Articles

Treatment of intractable pruritus in patients with cholestasis with molecular adsorbents recirculating system dialysis: a case series.

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Antoszewska M, Spychalski P, Elisabeth Villadsen G, Kristian Muff Aagaard N. Treatment of intractable pruritus in patients with cholestasis with molecular adsorbents recirculating system dialysis: a case series. Gastroenterology Review/Przegląd Gastroenterologiczny. 2021;16(3):254-256. doi:10.5114/pg.2021.108992. APA Antoszewska, M., Spychalski, P., Elisabeth Villadsen, G., & Kristian Muff Aagaard, N. (2021). Treatment of intractable pruritus in patients with cholestasis with molecular adsorbents recirculating system dialysis: a case series. Gastroenterology Review/Przegląd Gastroenterologiczny, 16(3), 254-256. https://doi.org/10.5114/pg.2021.108992 Chicago Antoszewska, Magdalena, Piotr Spychalski, Gerda Elisabeth Villadsen, and Niels Kristian Muff Aagaard. 2021. "Treatment of intractable pruritus in patients with cholestasis with molecular adsorbents recirculating system dialysis: a case series". Gastroenterology Review/Przegląd Gastroenterologiczny 16 (3): 254-256. doi:10.5114/pg.2021.108992. Harvard Antoszewska, M., Spychalski, P., Elisabeth Villadsen, G., and Kristian Muff Aagaard, N. (2021). Treatment of intractable pruritus in patients with cholestasis with molecular adsorbents recirculating system dialysis: a case series. Gastroenterology Review/Przegląd Gastroenterologiczny, 16(3), pp.254-256. https://doi.org/10.5114/pg.2021.108992 MLA Antoszewska, Magdalena et al. "Treatment of intractable pruritus in patients with cholestasis with molecular adsorbents recirculating system dialysis: a case series." Gastroenterology Review/Przegląd Gastroenterologiczny, vol. 16, no. 3, 2021, pp. 254-256. doi:10.5114/pg.2021.108992. Vancouver Antoszewska M, Spychalski P, Elisabeth Villadsen G, Kristian Muff Aagaard N. Treatment of intractable pruritus in patients with cholestasis with molecular adsorbents recirculating system dialysis: a case series. Gastroenterology Review/Przegląd Gastroenterologiczny. 2021;16(3):254-256. doi:10.5114/pg.2021.108992.

‘Out‐patient’ albumin dialysis for cholestatic patients with intractable pruritus

Intractable pruritus is a major problem for some patients with cholestasis. Albumin dialysis has been shown to ameliorate pruritus, but long-term outcome data are limited. To evaluate the safety and efficacy of 'out-patient' albumin dialysis using the molecular adsorbent recirculating system (MARS) in the treatment of intractable pruritus in cholestatic patients referred for liver transplantation for symptomatic relief. Fifteen patients who failed to respond to standard medical therapy to control pruritus were included. Three MARS (6h) sessions were performed per admission, and were repeated, if necessary. The intensity and severity of itch was quantified using itch severity and visual analogue scales (ISS and VAS). Molecular adsorbent recirculating system treatment was safe and associated with immediate and complete response in 11 patients; two patients had a partial response and two patients had no response. Thirty-four treatments were performed during a follow-up period of 15.7months (3-46) with patients requiring a mean of two admissions (1-6). The mean VAS and ISS improved significantly (both P<0.001) with improvement in the patient's perception of their quality of life. The duration of acceptable relief in responders was 3.3months (range 2-5). No serious adverse events were recorded, but the platelet count and haemoglobin were reduced significantly. Molecular adsorbent recirculating system therapy delivered in an 'out-patient' setting is safe and effective with a high degree of patient acceptability. Albumin dialysis can be considered a viable therapeutic option for patients with severe intractable pruritus, in whom, the only other effective treatment option is liver transplantation.

Therapy of Intractable Pruritus With MARS

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.

Liver Transplantation for Cholestatic Liver Disease.

Liver transplantation is an effective form of therapy for patients with end-stage cholestatic disease that improves both survival and quality of life. Liver transplantation is very effective for the treatment of intractable pruritus but less effective for the treatment of lethargy. Survival rates are good (more than 70% at 5 years); these patients are at greater risk of developing acute and chronic rejection and are more likely to require long-term immunosuppression. Primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC) recur in the graft. Recurrent PSC may be difficult to differentiate from secondary sclerosing cholangitis, but it recurs in up to 60% of patients at 5 years and may reduce graft survival. PBC recurrence, noted in up to 40% of patients at 10 years, has little effect on graft survival with respect to cancers. Patients with PSC are at greater risk of both colonic cancer (which may be reduced by ursodeoxycholic acid) and cholangiocarcinoma. Diagnosis of cholangiocarcinoma before transplantation usually contraindicates transplantation. The main challenges facing liver transplantation are the need to expand the donor pool and the need to find immunosuppressive regimens with fewer long-term toxicities.

Extracorporeal support of the failing liver.

Successes in machine-based extracorporeal support for different organ functions stimulated research in the field of liver support approximately 50 years ago. Initial failure to improve outcome using detoxification methods like dialysis, blood and plasma exchange, or plasmapheresis over sorbents fueled interest in biologic liver support concepts using bioreactors or combined methods. New device configurations, technical improvement of existing detoxification methods, and the refinement in cell culture techniques led to a boost in research on biologic and nonbiologic approaches. Currently, many systems are in the preclinical phase or have entered clinical studies. A number of completed clinical trials have reported a favorable therapeutic impact of the most advanced solutions on the course and outcome of liver failure. Often, findings must be reconfirmed. However, current knowledge suggests that extracorporeal liver support can successfully stabilize liver function, improve the clinical condition of patients, and considerably improve survival in certain subgroups of patients with fulminant hepatic failure and acute decompensation of chronic hepatic failure. Although the initial focus of liver support methods was bridging to liver transplantation, bridging to recovery of organ function and treatment of intractable pruritus are now valuable indications.