Liver transplantation for intractable pruritus is contraindicated before an adequate trial of opiate antagonist therapy

A woman with stage III (pre-cirrhotic) primary biliary cirrhosis was referr ed for liver transplantation because of intractable pruritus. Oral administ ration of 50 mg naltrexone precipitated a severe opioid withdrawal-like rea ction. Subsequently, when oral naltrexone therapy was reintroduced followin g a cautious infusion of naloxone, no reaction occurred and the pruritus re solved completely. Liver transplantation should not be considered for appar ently intractable pruritus of cholestasis before an adequate trial of opiat e antagonist therapy. (C) 2001 Lippincott Williams & Wilkins.