Comparison Between the Internal and External Pressure Filtration Method of Cell‐Free and Concentrated Ascites Reinfusion Therapy Using the Same Cancerous Ascites

Abstract

Cell‐free and concentrated ascites reinfusion therapy (CART) by internal filtration pressure method (internal method) and external filtration pressure method (external method) using the same cancerous ascites was performed. The rate of rise in circuit pressure and recovered components were compared between the two methods. The factors related to circuit pressure rise were also researched. In both methods, circuit pressure rose in 50% of cases. The recovery rates of IgG, IgA, IgM, and haptoglobin were significantly higher for the internal method than for the external method, whereas the recovery rate of α1‐antitrypsin was significantly lower in the internal method than in the external method. The levels of IL‐6, haptoglobin, α1‐antitrypsin, and fibrinogen/fibrindegradation products (FDP) in the original ascites were significantly higher in the group wherein circuit pressure rose than in that without circuit pressure rise. These proteins might be related to the rise in circuit pressure.

Ultrastructural observation of filtration membrane in cell‐free and concentrated ascites reinfusion therapy for malignant ascites

“…As shown in Tables 2 and 3 , the tendency of higher total protein levels was observed in both the fibrin and cellular‐deposition groups, suggesting that protein density is essential in deposit formation. This is consistent with previous studies that reported the association of higher total protein levels with increased circuit pressures and low protein recovery rates [ 6 , 7 ].…”

“…These pathological conditions may be associated with the fibrin deposition on the filtration membrane. Our results are consistent with those of a previous study that reported that markers of inflammation and coagulation in malignant ascites are associated with an increase in circuit pressure during CART [ 7 ].…”

“…Malignant ascites samples that resulted in fibrin deposition had higher levels of IL‐6, α1‐antitrypsin, haptoglobin, and FDP than those that did not result in fibrin deposition, and the number of blood cells did not differ between the two groups. IL‐6, α1‐antitrypsin, and haptoglobin are pro‐inflammatory proteins [ 7 , 10 ], and FDP is a marker of coagulation and fibrinolysis. Generally, inflammation and coagulation or fibrinolysis are enhanced in patients with malignancy [ 11 ].…”

“…Second, this study did not determine the association between fibrin deposition and an increase in circuit pressure as pressure increases were not observed in cases with fibrin deposition. Yamada et al recently reported that ascitic FDP levels were elevated in samples that resulted in increased circuit pressures, suggesting that increases in circuit pressure may be associated with the activation of the coagulation fibrinolysis system [ 7 ]. In our study, heparin was added to the original samples, which may have prevented the increase in circuit pressure during filtration.…”

“…CART was originally indicated for hepatic ascites in patients with cirrhosis, though the use of CART for malignant ascites has recently increased [ 2 , 6 ]. However, increases in circuit pressure and cessation of the procedure often occur when CART is used for patients with malignant ascites, leading to protein loss [ 6 , 7 ]. To achieve a more effective CART, a study regarding the precise mechanism of circuit pressure increase and circuit obstruction is necessary.…”