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

Hanafusa, Norio; Isoai, Ayako; Ishihara, Takeshi; Inoue, Tetsuya; Ishitani, Ken; Utsugisawa, Taiju; Yamaka, Toshihiko; Ito, Tetsuya; Sugiyama, Hiroshi; Arakawa, Atsushi; Yamada, Yosuke; Itano, Yasuo; Onodera, Hirokazu; Kobayashi, Ryosuke; Torii, Naoko; Numata, Toyoko; Kashiwabara, Taihei; Matsuno, Yoshihiro; Kato, Masaaki

doi:10.1371/journal.pone.0177303

Cited by 39 publications

(83 citation statements)

References 22 publications

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“…Cell-free and Concentrated Ascites Reinfusion Therapy (CART) has recently been performed for some cirrhotic patients with intractable massive ascites. CART offers some advantages over albumin administration (23). CART can reduce the need for Alb supplementation.…”

Section: Multivariatementioning

confidence: 99%

“…CART can reduce the need for Alb supplementation. This is because components of drainage fluid other than albumin, such as globulins and other factors, might effectively benefit the course of perioperative patients, and CART can prevent loss of such beneficial components (24). Moreover, preoperative use of CART could promote the activity of patients waiting for LT, helping to prevent progression to severe sarcopenia.…”

Section: Multivariatementioning

confidence: 99%

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Preoperative Ascites and/or Pleural Effusion Was a Predictor of Massive Albumin Use After Liver Transplantation

Kamo¹,

Kaido²,

Uozumi³

et al. 2019

SGO

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Background: Albumin (Alb) is often administered for patients undergoing liver transplantation (LT). However, the current status of Alb use after LT is unclear. We examined the current status of postoperative Alb administration and factors associated with massive Alb use after LT. Methods: A total of 122 consecutive patients who underwent adult-to-adult LT between January 2013 and August 2017 were divided into 2 groups according to total amount of Alb used after LT: High group, Alb ≥ 1000 g; and Low group, Alb <1000 g. Characteristics of postoperative Alb use in living-donor LT (LDLT) and deceased donor LT (DDLT) were compared. Moreover, independent predictive factors for massive Alb administration after LDLT were analyzed. Results: The amount of postoperative Alb use did not differ between LDLT and DDLT. In the High group, days of Alb administration and maximum daily volume of ascites discharge were significantly higher, cases with preoperative ascites and/or pleural effusion were more frequent, incidences of cytomegalovirus infection and bacteremia were higher, and prothrombin time-international normalized ratio was longer compared with the Low group. Preoperative ascites and/or pleural effusion was an independent predictive factor before LT. Conclusion: Preoperative ascites and/or pleural effusion was a predictor of massive Alb use after LT.

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Section: Multivariatementioning

confidence: 99%

Section: Multivariatementioning

confidence: 99%

Preoperative Ascites and/or Pleural Effusion Was a Predictor of Massive Albumin Use After Liver Transplantation

Kamo¹,

Kaido²,

Uozumi³

et al. 2019

SGO

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“…Cell-free and concentrated ascites reinfusion therapy (CART) is an effective treatment for recycling ascites proteins to improve ascites tension and improve dyspnea in patients with refractory ascites. 1,2 Recently, CART has been frequently used in malignant ascites in patients with ovarian cancer and cancerous peritonitis. [3][4][5] In malignant ascites, macrophages and lymphocytes produce inflammatory cytokines such as IL-6 in response to inflammation and infection associated with peritonitis.…”

Section: Introductionmentioning

confidence: 99%

“…6 The concentrated solution purified during the CART process concentrates not only useful proteins, but also IL-6 which has a molecular weight of 20-30 kDa and induces fever during intravenous injection. 1,7 IL-6 is involved in tumorigenesis and the production of acute phase proteins such as complement reactive protein and serum amyloid A (SAA) protein. 8 Additionally, IL-6 is thought to promote body protein degradation, suppress albumin (ALB) production, and further promote cancer cachexia.…”

Section: Introductionmentioning

confidence: 99%

Suppression of inflammation during cell‐free concentrated ascites reinfusion therapy using a blood purification device

et al. 2020

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In recent years, cell‐free concentrated ascites reinfusion therapy has been used to treat patients with malignant ascites. However, concentrated ascites reinfusion therapy involves enrichment and reinfusion of useful proteins and inflammatory cytokines. Therefore, fever is a primary side effect and significant problem for patients with ascites. We removed IL‐6, an inflammatory cytokine, by mixing malignant ascites and the hexadecyl group adsorbent from a β2‐microglobulin‐adsorbing column (Lixelle S‐15). As a result, the hexadecyl group adsorbent did not adsorb the albumin of malignant ascites but adsorbed 43% of IL‐6. To investigate the effect of the hexadecyl group adsorbent on hepatocytes, the adsorbed ascites was added to a human hepatoma cell line (HepG2), and the gene expression levels of albumin and serum amyloid A protein were examined. After absorption, ascites showed significantly suppressed serum amyloid A protein expression and significantly increased albumin gene expression compared to before adsorption. Our results suggest that incorporation of Lixelle to filter and concentrate malignant ascites can suppress inflammatory responses and reduce the inhibition of albumin synthesis in the liver after reinfusion.

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“…CART was approved by Japan National Health Insurance in 1981 and was initially used for cirrhotic ascites. At present, it is widely used in malignant ascites accompanied by carcinomatous peritonitis .…”

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confidence: 99%

A Method for Stabilizing the Proportion of the Reduced Form of Albumin During Cell‐Free and Concentrated Ascites Reinfusion Therapy in Patients with Malignant Ascites

et al. 2019

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Cell‐free and concentrated ascites reinfusion therapy (CART) is used to treat malignant ascites. However, the qualities of albumin in malignant ascites, such as antioxidative activity, may decrease owing to oxidative stress caused by cancer cells and inflammatory reactions. We investigated the fraction percentages of mercaptalbumin (HMA%, reduced form) and non‐mercaptalbumin (HNA%, oxidized form) in malignant ascites from 21 patients who received CART and compared the HMA% in the malignant ascites and human serum albumin (HSA) preparations. HMA% of albumin in malignant ascites (22.5%) was significantly lower than that in HSA preparation (42.2%). To ensure a high HMA%, we added L‐cysteine to the paracentesis‐treated ascites followed by dialysis 1 h later. As a result, the HMA% of albumin in malignant ascites was increased to 59.1%. Our results suggest that using this method in CART will improve patient's albumin quality.

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

Cited by 39 publications

References 22 publications

Preoperative Ascites and/or Pleural Effusion Was a Predictor of Massive Albumin Use After Liver Transplantation

Preoperative Ascites and/or Pleural Effusion Was a Predictor of Massive Albumin Use After Liver Transplantation

Suppression of inflammation during cell‐free concentrated ascites reinfusion therapy using a blood purification device

A Method for Stabilizing the Proportion of the Reduced Form of Albumin During Cell‐Free and Concentrated Ascites Reinfusion Therapy in Patients with Malignant Ascites

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