Effectiveness of Cell-Free and Concentrated Ascites Reinfusion Therapy in the Treatment of Malignancy-Related Ascites: A Systematic Review and Meta-Analysis

Abstract

Background: Malignancy-related ascites (MRA) is one of the symptoms causing discomfort in advanced cancer patients. Cell-free and concentrated ascites reinfusion therapy (CART) is one of the palliative treatments widely conducted in Japan only. Methods: A systematic review following a meta-analysis of CART was performed. The efficiency and adverse events were evaluated. Results: A total of 2567 patients and 6013 procedures of CART were identified in this study. The mean volume of MRA collected was 4.29 (95% confidence interval (CI) 3.47–5.11) L, and the volume reinfused after concentrating was 0.49 (95% CI 0.39–0.60) L. A total of 86.1 (95% CI 77.1–95.2) g protein and 42.9 (95% CI 36.0–50.0) g albumin was reinfused. The mean time to the next paracentesis was 20.7 (95% CI 15.6–25.8) days. The body weight was reduced by 3.38 (95% CI 1.90–4.86; p < 0.01) kg, and abdominal circumference was reduced by 7.86 (95% CI 6.58–9.14; p < 0.001) cm. Serum albumin increased an average of 0.14 (95% CI −0.01–0.28; p = 0.07) mg/dL the day after CART. Abdominal distension, dyspnea, and fatigue were alleviated by 6.0 (95% CI 5.59–6.51), 2.66 (95% CI 2.05–3.28), and 2.64 (95% CI 1.86–3.42) points using a numerical rating scale system ranging from 0 to 10. Overall, 17% (95% CI 0.03–0.31%) of patients had improved performance status after CART. Significant body temperature elevation was observed, at an average of 0.4 °C (95% CI 0.18–0.62 °C). Conclusions: CART might be a safe and effective palliative therapy in MRA and further clinical trials are necessary.

Cell‐free and concentrated ascites reinfusion therapy versus large‐volume paracentesis for the treatment of cirrhotic patients with refractory ascites: A multicenter prospective observational study

“…15 Other expected benefits include reduced weight and subjective distress, increased serum albumin levels, food intake, urine output, and improved QOL. [16][17][18][19] However, its disadvantages include increased body temperature, cost of equipment, and time required for the procedure. 5,6,15 Therefore, this therapy should be avoided, particularly in patients with high endotoxin levels in the ascites fluid and spontaneous bacterial peritonitis.…”

“…Therefore, one of the major advantages of CART is a reduction in albumin preparation using autologous proteins 15 . Other expected benefits include reduced weight and subjective distress, increased serum albumin levels, food intake, urine output, and improved QOL 16–19 . However, its disadvantages include increased body temperature, cost of equipment, and time required for the procedure 5,6,15 .…”

The complex role of IL-10 in malignant ascites: a review

“…There is no clear guidance on managing MA, but the treatments mainly fall into either relieving symptoms or controlling the primary diseases. Intermittent paracentesis is the most widely used intervention for controlling MA clinically, and its modified technique, cell-free and concentrated ascites reinfusion therapy is applied in Japan, which is thought to avoid protein loss compared with conventional paracentesis [ 17 ]. However, paracentesis relieves symptoms temporarily, with the ascites rapidly reaccumulating, increasing the risks of rehospitalization and deteriorating the quality of life (QOL) [ 16 ].…”