Reinfusion of concentrated ascitic fluid versus total paracentesis : A randomized prospective trial

We compared the efficacy and safety of apheresis and reinfusion of concentrated ascites (ARCA) versus total paracentesis plus intravenous albumin (PARA) in a prospective trial on cirrhotic patients with tense ascites. Twenty-four patients were randomized to either ARCA (N = 12) or PARA (N = 12), and...

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Bibliographic Details
Published in:Digestive diseases and sciences 1997-08, Vol.42 (8), p.1708-1714
Main Authors: GRAZIOTTO, A, ROSSARO, L, INTURRI, P, SALVAGNINI, M
Format: Article
Language:English
Subjects:
Adult
Aged
Ascites - therapy
Ascitic Fluid
Atrial Natriuretic Factor - blood
Biological and medical sciences
Blood Component Removal
Female
Gastroenterology. Liver. Pancreas. Abdomen
Humans
Infusions, Intravenous
Liver Cirrhosis - blood
Liver Cirrhosis - therapy
Liver. Biliary tract. Portal circulation. Exocrine pancreas
Male
Medical sciences
Middle Aged
Other diseases. Semiology
Paracentesis
Prospective Studies
Recurrence
Renin - blood
Serum Albumin - administration & dosage
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Summary:We compared the efficacy and safety of apheresis and reinfusion of concentrated ascites (ARCA) versus total paracentesis plus intravenous albumin (PARA) in a prospective trial on cirrhotic patients with tense ascites. Twenty-four patients were randomized to either ARCA (N = 12) or PARA (N = 12), and followed for two years. Sex, age, Child's class, and renal and liver function were similar in the two groups. The times the procedures were 2.7 +/- 1.0 (ARCA) vs 2.2 +/- 1.1 (PARA) hr, with removal of 8.8 +/- 3.5 (ARCA) and 6.9 +/- 3.4 (PARA) liters of ascites and intravenous infusion of 59.8 +/- 35.2 (ARCA) and 42.5 +/- 20.5 (PARA) g of albumin. Both procedures were safe. Biochemical signs of coagulative disturbances having no clinical relevance were observed after ARCA, with an increase in prothrombin time (P = 0.005) and serum FSP (P = 0.02). No significant changes in renal function, serum albumin, or plasma and urinary electrocytes were shown. Plasma renin activity increased after PARA (P = 0.02) and plasma atrial natriuretic factor increased after ARCA (P = 0.008), although no differences were observed in diuresis in the immediate follow-up. During the long-term follow-up, patient survival and recurrence of tense ascites were the same in both groups. We conclude that apheresis and reinfusion of concentrated ascites are as safe and effective as total paracentesis with albumin infusion for the treatment of tense ascites in cirrhotic patients.
ISSN:0163-2116
1573-2568
DOI:10.1023/a:1018865516168