Cell‐Free and Concentrated Ascites Reinfusion Therapy for Decompensated Liver Cirrhosis

Abstract

Cell-free and concentrated ascites reinfusion therapy (CART) is expected to improve symptoms associated with refractory ascites of the decompensated liver cirrhosis patients. The aim of this study was to evaluate the safety and efficacy of the CART system performed on the decompensated liver cirrhosis patients. In this retrospective observational study, we evaluated 24 CART processes performed on 11 patients with decompensated liver cirrhosis. We evaluated the effectiveness and adverse events during CART procedures. The amounts of collected and concentrated ascites were 4491.7 ± 2222.8 mL (mean ± SD), respectively, and the concentration ratio was 22.4 ± 15.3 times, respectively. The amount of collected protein in ascites was 2.3 ± 0.5 g/dL, and concentration ratio of protein was 8.2 ± 9.4 times. Serum protein level was not significantly different between before and after CART sessions. Thus, CART allowed for the reduction of doses of albumin preparations (Alb) to be administered. CART has been reported to cause two adverse reactions: elevation of body temperature and decrease in blood pressure. In our study, decreased blood pressure was not observed even in patients with > 5 L of ascites drained. Although a transient elevation in body temperature was seen in only one patient, this febrile patient immediately returned to normal body temperature with the use of NSAIDs. In patients with refractory ascites of decompensated liver cirrhosis in whom complete cure cannot be expected, CART improves their QOL and, in terms of medical economy, allows for the reduction of doses of Alb. CART can be effectively applied as a palliative procedure for refractory ascites of decompensated liver cirrhosis patients.

Technical Performance and Clinical Effectiveness of Drop Type With Adjustable Concentrator‐Cell Free and Concentrated Ascites Reinfusion Therapy

“…Finally, a combination of protein and concentrated ascites are reinfused into a patient vein. CART is believed to prevent prerenal failure and hypoalbuminemia caused by frequent abdominocentesis and improve abdominal distension, anorexia, and other symptoms . Recently, more aggressive CART‐related treatment, such as combination with dendritic cell vaccine therapy or anticancer agent administration into the abdominal cavity, has shown considerable promise .…”

Protein Concentration of Refractory Ascites in Cancer Patients is Reflected by the Presence and Severity of Peritoneal and Liver Metastasis

“…The use of cell‐free and concentrated ascites reinfusion therapy (CART) for refractory ascites in cancer patients has been steadily increasing . CART removes ascites from the abdominal cavity for the recovery of proteins and other essential substances after eliminating cells and bacteria from ascitic fluid by means of filter membranes . In simple abdominocentesis, patients may lose excessive protein and develop acute prerenal failure or hypoalbuminemia .…”

Development of a novel automatic ascites filtration and concentration equipment with multi‐ring‐type roller pump units for cell‐free and concentrated ascites reinfusion therapy

“…[1][2][3] CART was approved in Japan in 1981 by the National Health Insurance and was initially performed in patients with hepatic ascites caused by liver cirrhosis. 4,5 Recently, CART has been widely performed in patients with malignant ascites and more than 85% of patients who underwent CART had malignant ascites as reported in the post-marketing surveillance. 6 CART comprises three processes: (a) drainage process, which involves the collection of ascites by paracentesis; (b) filtration and concentration process, which involves the complete removal of cell components and bacteria using a filtration filter and removal of superabundant water using a concentration filter; and (c) treated ascitic intravenous drip infusion process.…”

“…The ascites processing in CART had been performed using a drop-type method, 12 an aspiration-type method (KM-CART), 13 a pump-type method using the roller pump equipment without the mode for CART, 14,15 a combination of these methods (eg, DC-CART), 16 and a pump-type method using the expensive multi-purpose blood processing equipment with the mode for CART. 5 At the priming phase, the filtration filter must be checked for any leaks to prevent the contamination of cancer cells or bacteria by the corruption of the hollow fiber. 17 Using the multi-purpose blood processing equipment with the mode for CART, this leak check is automatically carried out, but is performed in other methods manually.…”