Prospective study comparing human albumin vs. reinfusion of ultrafiltrate-ascitic fluid after total paracentesis in cirrhotic patients with tense ascites

Abstract

Although, total paracentesis associated with human albumin substitution has shown to be a rapid, effective and safe treatment of diuretic refractory ascites in advanced liver cirrhosis, it implies high costs and has a limited availability. Therefore an alternative procedure the reinfusion of concentrated ascites has gained popularity in recent years (Smart et al. 1990; Grazioto et al. 1997). It was the aim of the study to compare human albumin substitution vs. reinfusion of ascitic-ultrafiltrate after total paracentesis. 35 patients with cirrhosis and tense ascites received total paracentesis associated with either human albumin (5-8 g/l ascites) (= group A) or reinfusion of an ascitic-ultrafiltrate fluid by means of hemofiltration technique (= group B). The mean volume of ascites removed was 9.41 (2.1-20.0) in group A and 11.41 (6.5-21.0) in group B. No significant differences in serum electrolytes, liver and renal function, coagulation profiles and hormones of the renin-angiotensin-aldosterone system were observed during hospitalization. In both groups sodium excretion increased significantly. 43% of the patients in group B developed pyrexia and chill after reinfusion of the ascitic-ultrafiltrate fluid. In one patient an anaphylactic bronchospasm occurred requiring IUC-treatment. The treatment cost in case of human albumin were 326.-DM vs. 290.-DM for each patient treated with ascitic-ultrafiltrate fluid reinfusion. The probabilities of hospital readmission and survival were similar in both groups during follow-up. The results indicate that i.v. infusion of ascitic-ultrafiltrate fluid is as effective as total paracentesis and albumin infusion in case of diuretic refractory ascites. However, according to the costs of instruments and staff and due to the significant allergic reactions caused by ascitic fluid it cannot be considered as a real alternative to albumin substitution.

Single Center Experience of Cell‐Free and Concentrated Ascites Reinfusion Therapy in Malignancy Related Ascites

“…In our study, statistically significant decreased blood pressure was observed and confirmed in almost all cases after paracentesis, but we consider that such a decrease had no clinical significance as it did in Stephenson's report. Regarding body temperature, reinfusion of unfiltered and concentrated ascites reportedly caused fever higher than 38°C in 42.8% of patients, even though no bacterial contamination was found in reinfused ascites fluid . In this study, the observed changes were less than or equal to grade 1 in the scale of CTCAE ver.…”

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

“…Generally, fever is a clinically significant problem in CART [23], and the Kansai CART Study Group indicated that the processing speed was related to body temperature elevation [4]. Other possible factors involved are cytokines.…”

Characteristics of Patients and Their Ascites Who Underwent Repeated Cell‐Free and Concentrated Ascites Reinfusion Therapy

“…Borzio et al reported that 12% of their patients who received concentrated ascites developed fever and chills, even after infection in the ascites had been ruled out (5). Zaak et al reported that pyrexia and chills were observed in 43% of the patients, although the ultrafiltrate was found to be uninfected (6). In conventional CART, inflammatory substances such as interleukins are produced by white blood cells; when these cells are returned intravenously, they can cause high fevers because they are further concentrated via the concentrating membrane.…”