Efficacy and safety of cell‐free and concentrated ascites reinfusion therapy (CART) in gynecologic cancer patients with a large volume of ascites

Wang, Liangcheng; Okubo, Takashi; Shinsaka, Mamiko; Kobayashi, Akiko; Ogasawara, Miwa; Sakaguchi, Riko; Nagai, Tatsuo

doi:10.1111/jog.12763

Cited by 20 publications

(19 citation statements)

References 14 publications

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“…However, as no studies have specifically analyzed the frequency of adverse events for the other three types of CART, direct comparisons are impossible and further investigation is needed. A decline in hemoglobin level was also recognized after DC‐CART, which is another general phenomenon associated with CART . Rather than by hemorrhage, this was presumably due to plasma refilling of blood vessels following the injection of concentrated ascites, leading to dilution .…”

Section: Discussionmentioning

confidence: 95%

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

et al. 2017

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Cell-free and concentrated ascites reinfusion therapy (CART) is a very useful treatment method for refractory ascites but is difficult for many hospitals to employ due to its need for specialized equipment. We have therefore developed drop-type with adjustable concentrator CART (DC-CART) that uses a drop-type filtration mechanism and requires only a simple pump and pressure monitor for its concentration process. Easy adjustment of ascites concentration is possible through a recirculation loop, and filter membrane washing is aided by DC-CART's external pressure-type filtration to enable the processing of any quality or quantity of ascites. Moreover, the absence of a roller pump before filtration avoids inflammatory substance release from compressed cells. A total of 268 sessions of DC-CART using ascites from 98 patients were performed with good clinical results at our hospitals between January 2012 and June 2016. This report presents the detailed methods of DC-CART and summarizes its clinical effectiveness using patient ascites and blood data obtained from 59 sessions between March 2015 and February 2016. This novel technique successfully processed refractory ascites in numerous diseases with no serious adverse events. DC-CART could concentrate large amounts of ascites (from median weight: 4900 g [max: 20 200 g] to median weight: 695 g; median concentration ratio: 7.4), and a high amount of protein (median weight: 73 g [max: 294 g]) could be reinfused. Serum albumin levels were significantly increased (P = 0.010) and kidney function and systemic hemodynamics were well maintained in treated subjects. Additional concentration of ascites and adjustment of ascites volume were easily performed by recirculation (from median weight: 615 g to median weight: 360 g; median concentration ratio: 1.5). Time was needed during DC-CART for filter membrane cleaning, especially for viscous ascites. Overall, DC-CART represents a safe and useful treatment method for various forms of refractory ascites that can be performed at a wide range of health care institutions.

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Section: Discussionmentioning

confidence: 95%

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

et al. 2017

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“…However, CART is now widely used for patients with malignant ascites. The safety and efficacy of CART have been evaluated in several single-center studies [5–10], but only limited findings are available from a multicenter study [11]. Herein, we performed a post-marketing surveillance study to evaluate the safety and efficacy of CART mostly in patients with malignant ascites.…”

Section: Introductionmentioning

confidence: 99%

Safety and efficacy of cell-free and concentrated ascites reinfusion therapy (CART) in refractory ascites: Post-marketing surveillance results

et al. 2017

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We performed post-marketing surveillance to evaluate the safety and efficacy of cell-free and concentrated ascites reinfusion therapy (CART). In total, 356 CART sessions in 147 patients at 22 centers were performed. The most common primary disease was cancer (128 cases, 300 sessions). Mean amount of ascites collected was 3.7 L, and mean concentration ratio was 9.2. Mean amount of reinfused protein was 67.8 g (recovery rate, 72.0%). Performance status, dietary intake, urine volume, body weight and abdominal circumference were significantly improved after CART. Body temperature increased significantly, by 0.3°C on average. Concomitant steroids and/or NSAIDs use before reinfusion was significantly and negatively associated with increases in body temperature. Most adverse events were fever and chills. This study examined a large number of patients compared with previous studies, and showed that CART is an effective and relatively safe treatment for refractory ascites, such as malignant ascites.

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confidence: 99%

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

et al. 2019

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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.

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Efficacy and safety of cell‐free and concentrated ascites reinfusion therapy (CART) in gynecologic cancer patients with a large volume of ascites

Abstract: Massive ascites collection in CART < 9.2 L appears to be a safe and effective treatment for improving general condition, plasma protein, and electrolytes in gynecologic cancer patients.

Cited by 20 publications

References 14 publications

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

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

Safety and efficacy of cell-free and concentrated ascites reinfusion therapy (CART) in refractory ascites: Post-marketing surveillance results

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

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