Charcoal hemoperfusion in the treatment of medically refractory pruritus in cholestatic liver disease

Wonngarm Kittanamongkolchai, Ziad M El-Zoghby, J. Eileen Hay, Russell H. Wiesner, Patrick Sequeira Kamath, Nicholas F La Russo, Kymberly D. Watt, Carl H. Cramer, Nelson Leung

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: Pruritus is a distressing symptom in a considerable proportion of cholestatic patients and a few of them do not respond to conventional treatment. Charcoal hemoperfusion (CH) is an extracorporeal technique that is effective in eliminating protein-bound substances which may have accumulated during cholestasis. Several case reports have shown significant reduction of bilirubin in mechanical jaundice and neonatal hemolytic jaundice. However, the published data of CH for the treatment of refractory pruritus in cholestatic patients are scarce. Methods: Procedure code “Charcoal hemoperfusion” (90997) was used to identify patients who received CH at Mayo Clinic, Rochester, from 1 January 2000 to 5 January 2015. Patients who received CH for refractory cholestatic pruritus were retrospectively reviewed. Results: Thirteen patients were identified. A median of 5 (range 1–18) sessions for a total of 20 (1–72) h were performed. CH resulted in a significant decrease of pruritus in nine patients (69%). Two patients did not have significant relief and two patients did not pursue further treatments after having adverse reactions during the first session. Median pruritus numerical rating scale significantly decreased from 9/10 (9–10) to 4/10 (0–9) post-treatment (p = 0.004). Duration of symptom-free periods ranged from 8 to 90 days (median 18 days) in six patients who returned for follow-up. Most common adverse reactions were pain, bleeding from the catheter site and fever. Conclusion: CH temporarily improves the severity of medically refractory cholestatic pruritus in some patients. However, the improvement is not sustained and the short duration of benefit should be balanced with the invasive nature of the therapy and the relatively common adverse reactions.

Original languageEnglish (US)
Pages (from-to)1-6
Number of pages6
JournalHepatology International
DOIs
StateAccepted/In press - Dec 8 2016

Fingerprint

Hemoperfusion
Charcoal
Pruritus
Liver Diseases
Therapeutics
Neonatal Jaundice
Obstructive Jaundice
Cholestasis
Jaundice
Bilirubin
Fever
Catheters
Hemorrhage

Keywords

  • Charcoal hemoperfusion
  • Cholestasis liver disease
  • Pruritus

ASJC Scopus subject areas

  • Hepatology

Cite this

Charcoal hemoperfusion in the treatment of medically refractory pruritus in cholestatic liver disease. / Kittanamongkolchai, Wonngarm; El-Zoghby, Ziad M; Eileen Hay, J.; Wiesner, Russell H.; Kamath, Patrick Sequeira; La Russo, Nicholas F; Watt, Kymberly D.; Cramer, Carl H.; Leung, Nelson.

In: Hepatology International, 08.12.2016, p. 1-6.

Research output: Contribution to journalArticle

Kittanamongkolchai, Wonngarm ; El-Zoghby, Ziad M ; Eileen Hay, J. ; Wiesner, Russell H. ; Kamath, Patrick Sequeira ; La Russo, Nicholas F ; Watt, Kymberly D. ; Cramer, Carl H. ; Leung, Nelson. / Charcoal hemoperfusion in the treatment of medically refractory pruritus in cholestatic liver disease. In: Hepatology International. 2016 ; pp. 1-6.
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abstract = "Background: Pruritus is a distressing symptom in a considerable proportion of cholestatic patients and a few of them do not respond to conventional treatment. Charcoal hemoperfusion (CH) is an extracorporeal technique that is effective in eliminating protein-bound substances which may have accumulated during cholestasis. Several case reports have shown significant reduction of bilirubin in mechanical jaundice and neonatal hemolytic jaundice. However, the published data of CH for the treatment of refractory pruritus in cholestatic patients are scarce. Methods: Procedure code “Charcoal hemoperfusion” (90997) was used to identify patients who received CH at Mayo Clinic, Rochester, from 1 January 2000 to 5 January 2015. Patients who received CH for refractory cholestatic pruritus were retrospectively reviewed. Results: Thirteen patients were identified. A median of 5 (range 1–18) sessions for a total of 20 (1–72) h were performed. CH resulted in a significant decrease of pruritus in nine patients (69{\%}). Two patients did not have significant relief and two patients did not pursue further treatments after having adverse reactions during the first session. Median pruritus numerical rating scale significantly decreased from 9/10 (9–10) to 4/10 (0–9) post-treatment (p = 0.004). Duration of symptom-free periods ranged from 8 to 90 days (median 18 days) in six patients who returned for follow-up. Most common adverse reactions were pain, bleeding from the catheter site and fever. Conclusion: CH temporarily improves the severity of medically refractory cholestatic pruritus in some patients. However, the improvement is not sustained and the short duration of benefit should be balanced with the invasive nature of the therapy and the relatively common adverse reactions.",
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AU - Kittanamongkolchai, Wonngarm

AU - El-Zoghby, Ziad M

AU - Eileen Hay, J.

AU - Wiesner, Russell H.

AU - Kamath, Patrick Sequeira

AU - La Russo, Nicholas F

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AU - Leung, Nelson

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AB - Background: Pruritus is a distressing symptom in a considerable proportion of cholestatic patients and a few of them do not respond to conventional treatment. Charcoal hemoperfusion (CH) is an extracorporeal technique that is effective in eliminating protein-bound substances which may have accumulated during cholestasis. Several case reports have shown significant reduction of bilirubin in mechanical jaundice and neonatal hemolytic jaundice. However, the published data of CH for the treatment of refractory pruritus in cholestatic patients are scarce. Methods: Procedure code “Charcoal hemoperfusion” (90997) was used to identify patients who received CH at Mayo Clinic, Rochester, from 1 January 2000 to 5 January 2015. Patients who received CH for refractory cholestatic pruritus were retrospectively reviewed. Results: Thirteen patients were identified. A median of 5 (range 1–18) sessions for a total of 20 (1–72) h were performed. CH resulted in a significant decrease of pruritus in nine patients (69%). Two patients did not have significant relief and two patients did not pursue further treatments after having adverse reactions during the first session. Median pruritus numerical rating scale significantly decreased from 9/10 (9–10) to 4/10 (0–9) post-treatment (p = 0.004). Duration of symptom-free periods ranged from 8 to 90 days (median 18 days) in six patients who returned for follow-up. Most common adverse reactions were pain, bleeding from the catheter site and fever. Conclusion: CH temporarily improves the severity of medically refractory cholestatic pruritus in some patients. However, the improvement is not sustained and the short duration of benefit should be balanced with the invasive nature of the therapy and the relatively common adverse reactions.

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