‘Out‐patient’ albumin dialysis for cholestatic patients with intractable pruritus
Open accessAbstract
Summary: Background: 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. Aim: 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. Methods: Fifteen patients who failed to respond to standard medical therapy to control pruritus were included. Three MARS (6 h) 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). Results: 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 15.7 months (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 3.3 months (range 2–5). No serious adverse events were recorded, but the platelet count and haemoglobin were reduced significantly. Conclusion: 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.
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Physical approaches such as nasobiliary drainage, MARS, and UV light therapy are experimental, with case reports or series showing benefit but no formal trial evaluation.
“Physical approaches, such as nasobiliary drainage [206,189,207,208], molecular absorbance recirculating system (MARS) [209] and ultraviolet (UV) light therapy [210] are all experimental, with case reports/series showing benefit but no formal trial evaluation [210,211].”
From EASL Clinical Practice Guidelines: The diagnosis and management of patients with primary biliary cholangitis. (2017) · cites this paper as [211]
The Abstract (page unavailable) reports a 15-patient study in which MARS improved pruritus, supporting the claim that a small patient series showed benefit. The paper does not establish the claimed evidence status of nasobiliary drainage or UV light therapy, or show that none of these approaches has undergone formal trial evaluation. (LLM, conf=0.84)
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- Authors
- Leckie, P., Tritto, G., Mookerjee, R., Davies, N., Jones, D., & Jalan, R.
- Affiliations
- The Royal Free Hospital (GB)
- Newcastle University (GB)
- Corresponding author
- Jalan, R.
- Venue
- Alimentary Pharmacology & Therapeutics
- Publisher
- Wiley
- Published
- 2012-01-20
- Volume
- 35
- Issue
- 6
- Pages
- 696-704
- ISSN
- 0269-2813 (ISSN-L)
- 1365-2036
- OpenAlex
- W2120452779
- Semantic Scholar
- 80ab46b2039bd5010cc72deb4890d79a79bdd93c
- Cited by
- 51
- References
- 34
- Citations by year
- 2026: 2 · 2024: 3 · 2022: 5 · 2021: 4 · 2020: 3 · 2019: 1 · 2018: 2 · 2017: 8 · 2016: 5 · 2015: 6 · 2014: 2 · 2013: 1 · 2012: 9
- FWCI
- 3.65
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Alimentary Pharmacology & Therapeutics (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Newcastle University ePrints (Newcastle Univesity)
- Topics
- Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
- Health Sciences › Medicine › Hepatology › Liver Diseases and Immunity
- Health Sciences › Medicine › Dermatology › Dermatology and Skin Diseases
- Keywords
- intractable pruritus, cholestasis, albumin dialysis, molecular adsorbent recirculating system, outpatient dialysis, liver transplantation, pruritus severity, quality of life, platelet count reduction, hemoglobin decrease
- MeSH terms
- Adult, Aged, Albumins, Bile Acids and Salts, Cholestasis, Female, Follow-Up Studies, Renal Dialysis, Humans, Male, Middle Aged, Outpatients, Pain Measurement, Platelet Count, Pruritus, Quality of Life, Severity of Illness Index, Time Factors, Dialysis Solutions, Treatment Outcome
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