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

Abstract

Cell-Free and Concentrated Ascites Reinfusion Therapy (CART) is expected to improve patients' symptoms related to ascites. Use of a patient's own proteins in ascites might reduce the risk of infection. However, several reports have described that reinfusion of concentrated ascites might elevate body temperature. The aim of this study is to examine the safety and efficacy of the CART system performed exclusively on patients with malignancies. In this retrospective cohort observational study, we examined 81 CART processes performed on 24 patients with malignancies. Data were collected from medical records and records during processing of ascites. We investigated the effectiveness and adverse events during the procedures. The amount of ascites processed was 2.6 ± 1.4 L on average. The concentration ratio was 9.31 ± 5.45 on average. We found an increase in the urine volume after the procedure, which was significantly related to the amount of reinfused protein. The body temperature increased by 0.44°C. Systolic blood pressure decreased by 4 mm Hg after paracentesis, but no significant difference was found between the pressure before paracentesis and after reinfusion. In platelet counts, no significant change was observed. After all, no clinically significant adverse event was confirmed during CART procedures. Results show that CART can be performed safely even on patients with malignancy-related ascites and that the procedure might improve diuresis.

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

“…Compared with several previous epidemiological surveys [4, 5, 11], this study is distinguishable as it examined a larger number of patients including a large proportion of malignant ascites patients. On the other hand, the patients in the previous multicenter study reported by the Kansai CART Study Group in 2003 were mostly cirrhotic patients [4], and thus, the primary illness is markedly different from that in this study.…”

“…The standard CART procedure comprises three steps: i) drainage of the ascites into a designated bag by abdominal paracentesis; ii) removal of malignant cells and bacteria by filtration, and removal of excess fluid and electrolytes by concentration; and iii) reinfusion of the filtered and concentrated ascites [5]. A catheter or needle was used for abdominal paracentesis to drain ascites.…”

“…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.…”

Safety and Effectiveness of Cell-Free Concentrated Ascites Reinfusion Therapy in Gastric Cancer Patients with Refractory Ascites

“…CART is an expensive and timeconsuming method. Therefore, it is important to produce suitable CART method and determine appropriate patient's indication of CART [3,4].…”

“…CART comprises three processes, first step: paracentesis, second step: removal of cell components from ascites by filtration and concentrating ascetic fluid and last step: reinfusion of fluid obtained through this process [3].…”