(42al) Fundamental Study of Washed Cell-Free and Concentrated Ascites Reinfusion Therapy (w-CART)

Cell-free and concentrated ascites reinfusion therapy (CART) is treatment for refractory ascites by ultrafiltration and reinfusion of their ascites. Recently, CART is frequently performed as palliative care. However, adverse events such as more than 37.5°C fever were often reported. In order to prevent fever, high pre-dose of adrenal corticosteroid and antipyretics are frequently prescribed. The one of the cause of the fever may be concentrated cytokine that is included in the original ascites. In this study, we examined new CART method incorporating the washing process to remove cytokine fractions and purify albumin.

We performed in vitro normal CART and w-CART using 2700 mL of pseudo-ascites (Total protein was 3.0 g/dL), prepared using human plasma discarded by plasma exchange treatment, and concentrated spent dialysate containing maker solutes such as b2 and a1-microglobulin (MG). Molecular size of b2-MG (MW: 12kDa) and a1-MG (30kDa) is equivalent to the cytokine fraction. All experiments were performed under the approval of Ethics Committee of the University with respect to the collection of dialysate drainage. First, 300mL of concentrated ascites was obtained by normal CART operation. In addition, we mixed 2700 mL saline to a concentrated ascites and concentrated it again by filtration (washing process).

While maintaining the approximately 90% of albumin, not only urea but also larger solutes such as b2-MG, myoglobin (18kDa), prolactin (22kDa) and a1-MG were more removed by w-CART compared with conventional CART. These results indicated that w-CART could selectively remove cytokines without excessive loss of albumin compared with conventional CART. Newly proposed w-CART would be effective for preventing fever without pre-dose of adrenal corticosteroid and antipyretics.

Washed Cell-free and concentrated Ascites Reinfusion Therapy (w-CART) may be effective for removal of cytokines compared with conventional CART.