Successful use of the Molecular Adsorbent Recirculating System (MARS) in a patient with primary biliary cirrhosis (PBC) and treatment refractory pruritus

Primary biliary cirrhosis (PBC) is a chronic cholestatic liver disease often associated with severe pruritus. Despite maximal medical management pruritus often persists and has a detrimental effect on quality of life. For patients that are refractory to all medical treatments, more invasive approaches have been tried. Recently, a new extracorporeal hemodiafiltration method, Molecular Adsorbent Recirculating System (MARS), has been described. Based on the hypothesis that hydrophobic, protein-bound metabolites play a major role in the development of liver failure, this device uses an albumin enriched dialysate to facilitate the removal of albumin bound toxins. Aim: To assess the safety and efficacy of a single MARS treatment on the pruritus score in a patient with PBC and treatment refractory pruritus. Design/Patients: A 61-year-old female patient with biopsy proven PBC, who had been accepted on our liver transplantation waiting list because of treatment refractory pruritus, was subjected to a single MARS treatment. Results: At the end of a single 8 h MARS treatment session pruritus completely disappeared. Not unexpectedly, however, this effect was only short lived. Except for a slight hypercalcemia no adverse events were observed. Conclusion: A single MARS treatment very effectively improved pruritus. Long-term repetitive treatment, however, might be necessary to sustain its effectiveness.