Biochemical evaluation of processed ascites in patients undergoing <scp>cell‐free</scp> and concentrated ascites reinfusion therapy

Nakamura, Hironori; Hanafusa, Norio; Kitamura, K; Nakamura, Hiroaki; Sekihara, Hiroyuki; Shimizu, Kazuaki; Anayama, Mariko; Makino, Yasushi; Tamura, Katsuhiko; Nakagawa, Masaki

doi:10.1111/1744-9987.13541

Cited by 3 publications

(2 citation statements)

References 13 publications

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“…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).…”

Section: Discussionmentioning

confidence: 99%

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

Yorioka¹,

Namisaki²,

Shibamoto³

et al. 2023

In Vivo

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Background/Aim: The management of refractory ascites is critical for the treatment of patients with decompensated cirrhosis. This study aimed to evaluate the feasibility and safety of cell-free and concentrated ascites reinfusion therapy (CART) in patients with cirrhosis and refractory ascites, with a focus on changes in coagulation and fibrinolytic factors in ascitic fluid following CART. Patients and Methods: This was a retrospective cohort study including 23 patients with refractory ascites undergoing CART. Serum endotoxin activity (EA) before and after CART and the levels of coagulation and fibrinolytic factors and proinflammatory cytokines in original and processed ascitic fluid were measured. The Ascites Symptom Inventory-7 (ASI-7) scale was used for subjective symptom assessment before and after CART. Results: Body weight and waist circumference significantly decreased after CART, whereas serum EA did not significantly change after CART. Similar to the previous reports, ascitic fluid concentrations of total protein, albumin, high-density lipoprotein cholesterol, γ-globulin, and immunoglobulin G levels were significantly increased after CART; mild elevations in body temperature and interleukin 6 and tumor necrosis factor-alpha levels in ascitic fluid were also observed. Importantly, the levels of antithrombin-III, factor VII, and X, which are useful for patients with decompensated cirrhosis, were markedly increased in the reinfused fluid during CART. Finally, the total ASI-7 score was significantly lower following CART, compared with the pre-CART score. Conclusion: CART is an effective and safe approach for the treatment of refractory ascites that allows the intravenous reinfusion of coagulation and fibrinolytic factors in the filtered and concentrated ascites.Cirrhosis, which is a terminal-stage liver disease, is associated with serious complications including refractory ascites resulting in decline in quality of life (1). Every year, approximately 10% of patients with cirrhosis develop refractory ascites despite treatment with fluid restriction, conventional diuretics, and the vasopressin-2 antagonist tolvaptan (2). The overall survival probability is very poor in patients with decompensated cirrhosis and refractory ascites, with an approximate rate of 30% at 2 years, and more than 50% of these patients develop hepatorenal syndrome (3, 4). Refectory ascites carry a high symptom burden with associated pain, nausea, need for hospital admission and limitation of function and mobility.According to the Evidence-Based Clinical Practice Guidelines for Liver Cirrhosis 2020, resistance or poor response to diuretics is a clear indication for large-volume paracentesis (LVP) with albumin replacement or cell-free and concentrated ascites reinfusion therapy (CART) in 1226

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Section: Discussionmentioning

confidence: 99%

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

Yorioka¹,

Namisaki²,

Shibamoto³

et al. 2023

In Vivo

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“…Most patients with decompensated cirrhosis who develop large volumes of ascitic fluid notice abdominal distention, which may markedly impair the patients' quality of life (4). Evidencebased clinical practice guidelines for liver cirrhosis have shown that diuretic resistance or poor diuretic response is an indication for large abdominal paracentesis or cell-free and concentrated ascites reinfusion therapy (CART) (5,6), with fever, high blood pressure, headache, and shaking with chills having been reported as CART-related adverse events (7). Most patients experience high fever during the reinfusion of ascitic fluid (8), with evidence implicating endotoxin or inflammatory cytokines as a cause (9).…”

mentioning

confidence: 99%

Endotoxin Activity Reflects an Increase in Body Temperature in Cirrhotic Patients With Ascites Undergoing Cell-free and Concentrated Ascites Reinfusion Therapy

Namisaki¹,

Tsuji²,

Kitade³

et al. 2022

In Vivo

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Background: Ascites commonly complicates cirrhosis and is refractory to the vasopressin-2 antagonist tolvaptan and fluid restriction in approximately 60% of patients. We aimed to identify risk factors associated with adverse events following cell-free and concentrated ascites reinfusion therapy (CART) in patients with cirrhosis and ascites. Patients and Methods: We evaluated the efficacy and tolerability to the CART system in 18 patients with decompensated liver cirrhosis and ascites. We determined serum endotoxin activity using endotoxin activity (EA) assays and serum and ascitic fluid concentrations of interleukin 6 (IL6) and tumor necrosis factor-α (TNFα) before and after the CART procedures. Results: Body weight and waist circumference significantly decreased after CART (both p<0.001). Body temperature (BT) increased significantly at an average rate of 1.1˚C during CART (p<0.001). The change in BT was correlated with EA and not interleukin IL6 or TNFα. The rise in BT was positively correlated with serum EA levels at baseline. The increase in BT was significantly higher in the group with high EA (≥0.37) than in the low EAA group (<0.37) (p=0.02). TNFα and serum IL6 levels in ascites were significantly increased during CART (both p<0.001). However, no significant differences in the EA, serum TNFα or IL6 levels were found in ascitic fluid before and after the CART procedures. Conclusion: Although this discovery warrants further study, EA assay can indicate an increase in BT during effective CART in patients with cirrhosis and ascites.

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Distribution of therapeutic monoclonal antibodies into ascites in advanced gastric cancer patients with peritoneal metastasis: case reports and literature review

Kaneko

Doki

Yamada

et al. 2022

Cancer Chemother Pharmacol

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Biochemical evaluation of processed ascites in patients undergoing cell‐free and concentrated ascites reinfusion therapy

Cited by 3 publications

References 13 publications

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

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

Endotoxin Activity Reflects an Increase in Body Temperature in Cirrhotic Patients With Ascites Undergoing Cell-free and Concentrated Ascites Reinfusion Therapy

Distribution of therapeutic monoclonal antibodies into ascites in advanced gastric cancer patients with peritoneal metastasis: case reports and literature review

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