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Large-volume cell-free and concentrated ascites reinfusion therapy improves venous flow in patients with liver cirrhosis

  • Original Article–Gastroenterology
  • Published:
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Abstract

Purpose

Hemodynamic change after total paracentesis was investigated because it might lead to various complications. Although cell-free and concentrated ascites reinfusion therapy (CART) is safer and more effective than total paracentesis in theory, hemodynamic change after CART has been never reported. And previous studies did not mention hemodynamics of the venous system.

Methods

We investigated the hemodynamic change, including that of the venous system, before and after CART using color Doppler ultrasonography and fast Fourier transform analysis. Twenty-eight patients with tensive cirrhotic ascites underwent ultrasonography the day before and after total volume CART. The diameter and velocity of the main, right, and left portal vein; inferior vena cava (IVC); and right renal vein were measured using ultrasonography.

Results

A total of 11.8 ± 4.4 L of ascites (range 3.6–20.9 L) was filtered and concentrated to 0.85 ± 0.40 L (range 0.36–1.50 L). The diameter of the IVC increased from median 13.5 ± 5.4 mm (range 4–25 mm) to 18.5 ± 4.1 mm (range 7–29 mm) (p = 0.007). The diameter of the right segmental renal vein significantly increased after KM-CART [from 5.0 ± 1.0 (4–8) mm to 7.0 ± 2.0 (3–10) mm] (p = 0.011). Hemodynamic change of the portal venous system was not significant. The time to the next CART in patients with an IVC diameter ≥ 20 mm and < 20 mm was 86 days and 20.5 days (p = 0.035), respectively.

Conclusion

Tensive ascites results in venous congestion in patients with cirrhotic ascites. CART improved venous flow, but it did not change the hemodynamics of the portal venous system.

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Acknowledgements

The authors thank Masanori Abe (Professor, Division of Nephrology, Hypertension, and Endocrinology, Department of Medicine, Nihon University School of Medicine) for research support, and Editage (https://www.editage.jp/) for the English language review.

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, 30-1 Oyaguchi Kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan

    Naoki Matsumoto, Masahiro Ogawa, Tatsuo Kanda, Shunichi Matsuoka & Mitsuhiko Moriyama

  2. Ascites Treatment Center, Kanamecho Hospital, 1-11-13 Kanamecho, Toshima-ku, Tokyo, 171-0043, Japan

    Keisuke Matsusaki

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  1. Naoki Matsumoto
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  2. Masahiro Ogawa
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Correspondence to Naoki Matsumoto.

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This study was performed in accordance with the principles of the Declaration of Helsinki. Comprehensive informed consent regarding the use of data was obtained from each subject.

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Matsumoto, N., Ogawa, M., Kanda, T. et al. Large-volume cell-free and concentrated ascites reinfusion therapy improves venous flow in patients with liver cirrhosis. J Med Ultrasonics 48, 315–322 (2021). https://doi.org/10.1007/s10396-021-01094-2

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  • DOI: https://doi.org/10.1007/s10396-021-01094-2

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