Z Gastroenterol 2006; 44 - A5_17
DOI: 10.1055/s-2006-931787

Treatment of Severe Refractory Pruritus with Fractionated Plasma Separation and Adsorption (Prometheus®)

K Rifai 1, C Hafer 2, C Athmann 1, H Haller 2, D Fliser 2, MP Manns 1
  • 1Abt. Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, Hannover
  • 2Abt. für Nephrologie, Medizinische Hochschule Hannover, Hannover

Introduction: Severe pruritus is a serious complication of cholestatic liver disease. Prometheus® is a new extracorporeal liver support system combining high-flux hemodialysis and direct toxin adsorption of the patient`s albumin fraction (FPSA; fractionated plasma separation and adsorption). We prospectively evaluated the effect of Prometheus® therapy on patients with intractable pruritus.

Methods: Seven patients with severe pruritus refractory to all medical treatment efforts over >4 weeks were treated with Prometheus® (3–5 times, 18±3 hours total). Mean age was 48±17 years, 5/7 patients were male. Underlying liver disease was very heterogenous (1xPBC, PSC, SBC, SSC, CCC, chronic rejection, toxic hepatitis). For subjective assessment of pruritus, the visual analog scale (VAS) was used (from 0=no pruritus to 10=unbearable pruritus). VAS, serum bile acids and total bilirubin were evaluated directly before and after Prometheus® treatment as well as 4 weeks later.

Results: During Prometheus® therapy, VAS significantly dropped from 9±3 to 3±2 (p<0.006). Likewise, serum bile acids decreased (from 248±192 to 101±85µmol/l; p<0.03). Only the patient without initial bile acid elevation did not improve. Bilirubin levels were initially below 50µmol/l in 4/7 patients and therefore took a heterogenous course (from 375±505 to 189±198µmol/l; p=0.1). Regarding follow-up, one patient was lost and two patients were transplanted within 25 days. In two patients, the amelioration lasted only for few days. The other patients still had a slowly decreasing benefit after 4 weeks.

Conclusion: Prometheus® therapy significantly improved refractory pruritus in all patients with elevated bile acid levels. However, in some patients there was only a short-term benefit. Further studies are needed to better identify patient groups with a sustained response to this treatment.

Key words

Bilirubin - Gallensäuren - Leberersatzverfahren - Prometheus - Pruritus