Verification of serum albumin elevating effect of cell-free and concentrated ascites reinfusion therapy for ascites patients: a retrospective controlled cohort study

Abstract

Cell-free and concentrated ascites reinfusion therapy (CART) is frequently used to treat refractory ascites in Japan. However, its efficacy remains unclear. This controlled cohort study verified the serum albumin elevating effect of CART by comparisons with simple paracentesis. Ascites patients receiving CART (N = 88) or paracentesis (N = 108) at our hospital were assessed for the primary outcome of change in serum albumin level within 3 days before and after treatment. A significantly larger volume of ascites was drained in the CART group. The change in serum albumin level was +0.08 ± 0.25 g/dL in the CART group and −0.10 ± 0.30 g/dL in the paracentesis group (P < 0.001). The CART – paracentesis difference was +0.26 g/dL (95%CI +0.18 to +0.33, P < 0.001) after adjusting for potential confounders by multivariate analysis. The adjusted difference increased with drainage volume. In the CART group, serum total protein, dietary intake, and urine volume were significantly increased, while hemoglobin and body weight was significantly decreased, versus paracentesis. More frequent adverse events, particularly fever, were recorded for CART, although the period until re-drainage was significantly longer. This study is the first demonstrating that CART can significantly increase serum albumin level as compared with simple paracentesis. CART represents a useful strategy to manage patients requiring ascites drainage.

Feasibility, efficacy, and safety of cell‐free and concentrated ascites reinfusion therapy (KM‐CART) for malignant ascites

“…CART has enabled the preservation of albumin levels with a low rate of repeat drainage, probably because concentrated ascites fluid is reinfused 1 . Interestingly, the serum albumin levels significantly decreased following KM‐CART despite reinfusion of concentrated ascites, which was equal to the decrease following paracentesis (0.13 g/dL [Table 3] vs. 0.10 g/dL 1 ), but the treatment outcome was apparently better, probably for two reasons. One is an overestimation of the serum albumin level before KM‐CART due to significant dehydration on admission.…”

“…Although paracentesis alone is helpful for unloading, drainage of a large amount of ascites can lead to circulatory disturbances as in case 3 or significantly lower the serum albumin level, necessitating repeat drainage within 1 week in nearly half of patients. CART has enabled the preservation of albumin levels with a low rate of repeat drainage, probably because concentrated ascites fluid is reinfused 1 . Interestingly, the serum albumin levels significantly decreased following KM‐CART despite reinfusion of concentrated ascites, which was equal to the decrease following paracentesis (0.13 g/dL [Table 3] vs. 0.10 g/dL 1 ), but the treatment outcome was apparently better, probably for two reasons.…”

“…In patients with malignant peritonitis, ascites not only leads to the deterioration of patient quality of life (QOL), with signs such as abdominal distention, dyspnea, and appetite loss; but also impairs renal function and limits a patient's treatment options, including chemotherapy. Drainage of ascites alone results in loss of a large amount of protein, affects the systemic circulation, and often necessitates redrainage within a week 1 . Although peritoneovenous shunting enables the restoration of protein levels, 2 it potentially contributes to the spread of cancer cells and induces disseminated intravascular coagulation when performed on patients with malignant ascites 3 .…”

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

“…M-CART can prevent TMPs higher than the set value from being applied to the hollow fibers of the filtration filter by the automatic two-way drainage washing levels. 2,[6][7][8][9][10][13][14][15][16][20][21][22][23][24][25] The protein recovery rate decreases due to the following causes: (a) discontinuation of ascites processing due to clogging of the filtration or concentration filters; (b) loss of remaining ascites in the filters and circuit after ascites processing is completed; (c) loss of ascites due to washing of the filtration filter; and (d) protein adsorption to filter membrane. By M-CART, the total amount of ascites can be processed by automatic washing of clogged filtration filter and self-regulation of the concentration ratio.…”

“…CART is effective for the relief of symptoms and prevents the worsening of nutritional status through the drainage of ascites. [6][7][8][9] Furthermore, the use of a combination of chemotherapy and CART 10 and the application of sampling cells to cancer vaccines 11 were reported, and CART was recognized as an effective treatment that can support cancer therapy.…”