Shimizu Seiichi, Ohira Masahiro, Nakano Ryosuke, Imaoka Yuki, Sato Koki, Tahara Hiroyuki, Ide Kentaro, Kobayashi Tsuyoshi, Kuroda Shintaro, Ono Hiroaki, Tanaka Yuka, Ohdan Hideki
Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan; Medical Center for Translational and Clinical Research, Hiroshima University Hospital, Hiroshima, Japan.
Transplant Proc. 2019 Oct;51(8):2740-2744. doi: 10.1016/j.transproceed.2019.02.060.
Refractory ascites is one of the major complications of liver transplant (LT) and is associated with increased morbidity and mortality. The aim of this study was to analyze the efficacy and safety of novel cell-free and concentrated ascites reinfusion therapy (KM-CART) for the treatment of refractory ascites during preoperative living donor liver transplant.
Forty KM-CART procedures were performed on 8 liver transplant candidates. We investigated the safety and efficacy of KM-CART in terms of the processed ascites, adverse events, laboratory data, and patient condition.
By using KM-CART, an average of 12.5 L (range, 2.6-26.1 L) of ascites was filtered and concentrated to 0.5 L (range, 0.1-1.6 L) in 62 minutes (range, 8-187 minutes). Final products contained 21.5 g (range, 2.5-65.6 g) of albumin and 13.5 g (range, 1.5-61.8 g) of globulin. No endotoxin contamination was detected in the ascites. Although the incidence of adverse events was 35.0% (including fever, hypotension, bleeding, leg cramps, and nausea), all of these could be treated conservatively. Body weight and oral intake were significantly improved after KM-CART. Furthermore, the use of fresh frozen plasma for the LT recipients with KM-CART was significantly lower than that for patients without KM-CART. In addition, no patients lost their opportunity for LT because of adverse events due to KM-CART.
Our findings show that KM-CART could be a promising option for the treatment of refractory ascites during the preoperative period of LT. This study provides the foundation for further large-scale prospective studies.
