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

Abstract

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.

Development of a novel automatic ascites filtration and concentration equipment with multi‐ring‐type roller pump units for cell‐free and concentrated ascites reinfusion therapy

“…M-CART can prevent TMPs higher than the set value from being applied to the hollow fibers of the filtration filter by the automatic two-way drainage washing levels. 2,[6][7][8][9][10][13][14][15][16][20][21][22][23][24][25] The protein recovery rate decreases due to the following causes: (a) discontinuation of ascites processing due to clogging of the filtration or concentration filters; (b) loss of remaining ascites in the filters and circuit after ascites processing is completed; (c) loss of ascites due to washing of the filtration filter; and (d) protein adsorption to filter membrane. By M-CART, the total amount of ascites can be processed by automatic washing of clogged filtration filter and self-regulation of the concentration ratio.…”

“…15 In the DC-CART in which drop-type filtration from the outside of the hollow fibers to the inside was performed, a steroid was administered in 56% of the sessions prophylactically, and elevation of body temperature to >38°C appeared in 16.4% of the sessions. 16 The negative pressure-type filtration method using a roller pump was located after a filtration filter was adapted in M-CART to prevent the risk of the cell components of the ascites producing causative agents of the fever by the mechanical stimulation of the roller pump. In this study, steroids were administered prophylactically in 92.7% of the sessions, ascites was processed at a flow rate of 50 mL/min, and fever occurred in 17.1% of the CART sessions and 23.5% of the patients (4/17) and the degree of increase in body temperature was 0.53 ± 0.58°C.…”

Management of refractory cirrhotic ascites: challenges and solutions

“… 1 , 55 The cost–benefit problem should be definitely resolved for the further application of CART worldwide. Yamada et al 56 have recently developed a drop-type CART with adjustable concentrator (DC-CART) that uses a drop-type filtration mechanism. The DC-CART requires no specialized equipment except for a simple pump and pressure monitor.…”

“…The DC-CART requires no specialized equipment except for a simple pump and pressure monitor. 56 It could concentrate large amounts of ascitic fluid (from a median weight of 4900 to 695 g; median concentration ratio: 7.4) in 98 patients with refractory ascites including 14 cirrhotic patients.…”

Biochemical evaluation of processed ascites in patients undergoing cell‐free and concentrated ascites reinfusion therapy

“…Filtration methods are based on different parameters, such as positive pressure, negative pressure, and drop types. Furthermore, the final protein concentrations after the processing of ascites can be different 1,9 …”