Adverse effects of cell-free and concentrated ascites reinfusion therapy for malignant ascites: a single-institute experience

Abstract

Background Cell-free and concentrated ascites reinfusion therapy (CART) is a strategy for improving various intractable symptoms due to refractory ascites, including hypoalbuminemia. 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 weight of ascites before and after concentration was 4,720 g and 490 g (median concentration rate, 10.0-fold), The median amounts of total protein and albumin were 64.0 g and 32.6 g (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, weight of harvested and concentrated ascites, the ascites processing rate (filtration and concentration), weight of saline used for membrane cleaning, amount of calculated total protein for infusion, or prophylaxis against AEs; the reinfusion rate of ≥ 125 mL/h or ≥ 10.9 g/h of total protein affected the frequency of AEs, regardless of the prophylactic use of steroids. Conclusions The observed AEs were mainly mild reactions after reinfusion, which were related to a reinfusion rate of volume ≥ 125 mL/h, a simple indicator in practice, or total protein ≥ 10.9 g/h. 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.

Cell-free and concentrated ascites reinfusion therapy for refractory massive cardiac ascites in an adult with single ventricle haemodynamics: a case report

“…Reinfusion-related adverse events have been reportedly associated with a reinfusion rate of ≥125 mL/h or ≥10.9 g/h of total protein. 12 Administration of steroids and/or non-steroidal anti-inflammatory agents before reinfusion reportedly suppresses fever during CART. 2 In the present case, we selected acetaminophen because there were no findings of apparent liver dysfunction and to avoid renal dysfunction, which resulted in relieving both procedure-related pain and fever during CART.…”

Changes in Coagulation and Fibrinolytic Factors in Patients With Cirrhotic Refractory Ascites Undergoing Cell-free and Concentrated Ascites Reinfusion Therapy: A Retrospective Observational Study in Japan

“…In contrast, the IL-6 concentrations were reported to decrease with filtration and concentration processes during CART (25). While the reason for the discrepancy in proinflammatory cytokine levels remains unclear, differences in the reinfusion rate of the processed ascitic fluid across the studies are a possibility (10) (26,27). The infusion of IL-6 over a short period of time stimulates immune responses such as a rise in body temperature (25).…”

“…CART is difficult to conduct as ascites filtration and concentration is a complicated procedure. CART is associated with several adverse events, including shock, hypotension, chest pain, abdominal pain, dyspnea and hyperammonemia at puncture and drainage, and fever, chill, shivering, and hypotension (10). The Evidence-Based Clinical Practice Guidelines for Liver Cirrhosis 2020 suggests the infusion of 8 g/l albumin in therapeutic paracentesis in cases where the extracted ascites volume is ≥5 l. The guidelines also recommend paracentesis or CART for the treatment of refractory ascites (5,6).…”

Novel and highly reliable leak check tests for drop‐ and external pressure‐type cell‐free and concentrated ascites reinfusion therapy

“…In addition to these useful proteins, ascites may contain harmful substances, such as bacteria, endotoxins, and various cells, including malignant cells, white blood cells, and red blood cells. These substances may cause various adverse events if they enter the patient's circulatory system [3][4][5][6][7][8]. Therefore, it is necessary to remove these harmful substances from the collected ascites.…”