Supportive Care in Cancer

, Volume 26, Issue 5, pp 1489–1497 | Cite as

Efficacy and safety of reinfusion of concentrated ascitic fluid for malignant ascites: a concept-proof study

  • Rumi Hanada
  • Naosuke Yokomichi
  • Chihiro Kato
  • Kazumi Miki
  • Sachiko Oyama
  • Tatsuya Morita
  • Ryoko Kawahara
Original Article



Malignant ascites is one of the symptoms causing discomfort in advanced cancer patients. Cell-free and concentrated ascites reinfusion therapy (CART) is one treatment modality, but controlled trials are limited. The primary aim of this study was to explore the efficacy and safety of CART, as well as their predictors, to obtain data for planning a further controlled trial.


This was a single center retrospective cohort study in patients with refractory malignant ascites. Consecutive adult patients who underwent CART were enrolled. The primary endpoints were the time to next paracentesis and seven patient-reported symptoms (e.g., abdominal pain and distension). The secondary endpoints were adverse events, laboratory findings, and physical findings.


A total of 104 CART procedures for 51 patients were analyzed. The median time to next paracentesis was 27 days (95% CI, 21–35). Intensities of all seven symptoms were significantly improved after CART (p < 0.0001 for all symptoms). Grade 3 hypotension occurred during one procedure, and mild fever occurred in 5%. Total protein, albumin, and estimated glomerular filtration rate were significantly increased. Hemorrhagic ascites, ascites white blood cell count, serum total protein, and lymphocyte percentages were the independent predictors of the time to next paracentesis.


The effects of reinfusion of concentrated ascitic fluid may be maintained for 1 month, being potentially longer than that of total paracentesis alone. This study had no comparison groups and examined the short-term effect. A randomized controlled study to compare the long-term effects of total paracentesis alone vs. CART is necessary.


Ascites Malignancy Paracentesis Filtration Palliative care 


Funding information

This study was supported by Japan Society for the Promotion of Science KAKENHI Grant Number JP16H05212.

Compliance with ethical standards

The study was approved by the institutional review board of Nissay General Hospital.

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

520_2017_3980_MOESM1_ESM.docx (148 kb)
ESM 1 (DOCX 147 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2017

Authors and Affiliations

  1. 1.Department of Anesthesiology and Palliative CareNissay HospitalOsakaJapan
  2. 2.Seirei HospiceSeirei Mikatahara General HospitalShizuokaJapan
  3. 3.Clinical Engineering Laboratory, Division of Central Clinical Research LaboratoryNissay HospitalOsakaJapan
  4. 4.Department of NursingNissay HospitalOsakaJapan
  5. 5.Department of Palliative and Supportive Care, Palliative Care Team, and Seirei HospiceSeirei Mikatahara General HospitalHamamatsuJapan
  6. 6.Department of Palliative Care, Hoshigaoka Medical CenterOsakaJapan

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