Adverse Effects of Cell Free and Concentrated Ascites Reinfusion Therapy (CART) for Malignant Ascites: A Single Institute Experience

Abstract

Background: Cell-free and concentrated ascites reinfusion therapy (CART) is a strategy to improve hypoalbuminemia due to refractory ascites. CART has recently been applied in the treatment of cancer patients. This study was performed to assess the safety of CART in a single cancer institute.Methods: We retrospectively reviewed 233 CART procedures that were performed for 132 cancer patients in our institute. Results: The median volume of ascites before and after concentration was 4,720 and 490 mL (median concentration rate, 10.0-fold), The median amounts of total protein and albumin were 64.0g and 32.6g (median recovery rates, 44.9% and 49.0%), respectively. Thirty-three adverse events (AEs) were observed in 22 (9.4%) of 233 procedures; 30 of these events occurred after reinfusion. The most common reinfusion-related AEs were fever (13 events) and chills (10 events). Univariate analyses revealed no significant relationships between the frequency of AEs and age, sex, appearance of ascites, volume of harvested and concentrated ascites, the ascites processing rate (filtration and concentration), volume of saline used for membrane cleaning, amount of calculated total protein for infusion, or prophylaxis against AEs; the reinfusion rate >100 mL/h affected the frequency of AEs, regardless of the prophylactic use of steroids. Conclusions: The observed AEs were mainly mild cytokine-related reactions after reinfusion, which were related to a reinfusion rate of >100 mL per hour. Although our study was retrospective in nature and undertaken in a single institute, this information may be helpful for the management of cancer patients with refractory malignant ascites using CART.