title: A case of cell-free and concentrated ascites reinfusion therapy effective for refractory ascites in spontaneous bacterial peritonitis in a renal transplant patient.
abstract: A 58-year-old Japanese male with chronic hepatitis C underwent kidney transplantation from an unrelated donor in October 1998. In December 2004, the patient was admitted for spontaneous bacterial peritonitis (SBP). Abdominal paracentesis and albumin transfusion were performed, but control of ascites was poor. A randomized, controlled study of patients with SBP showed that patients receiving cefotaxime with a high-volume albumin transfusion (50-75 g/50 kg) were significantly less likely to have irreversible renal failure and had lower mortality. Japan, however, relies on imports for 70% of its albumin formulations, which complicates high-volume albumin transfusion. Consequently, albumin transfusion is often limited to single treatments in the range of only 25 g (25%, 100 ml). A single cell-free and concentrated ascites reinfusion therapy (CART) treatment can reinfuse approximately 60 g of albumin, corresponding to a high-volume albumin transfusion capable of reducing the associated risk of infection or allergic reaction. Though this case was an SBP patient, after the ascites were found to be negative for endotoxins, CART was performed, and control of ascites was achieved without observation of fever, hypotension, or other adverse effects. CART provides greater supplementation of albumin than albumin transfusion and can be an effective modality of treatment for hypoalbuminemia in SBP patients if ascites are negative for endotoxins.
authors.affiliation: Department of Nephrology and Kidney Center, Aso-Iizuka Hospital, Iizuka, Japan.
authors.forename: Atsuhiro
authors.initials: A
authors.lastname: Maeda
authors.forename: Kazuhito
authors.initials: K
authors.lastname: Takeda
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Tsuruya
authors.forename: Shuuhei
authors.initials: S
authors.lastname: Miura
authors.forename: Jirou
authors.initials: J
authors.lastname: Toyonaga
authors.forename: Satsuki
authors.initials: S
authors.lastname: Nakashita
authors.forename: Masahide
authors.initials: M
authors.lastname: Furushou
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Mukai
authors.forename: Yoshiharu
authors.initials: Y
authors.lastname: Mutou
authors.forename: Tomo
authors.initials: T
authors.lastname: Komaki
authors.forename: Keita
authors.initials: K
authors.lastname: Takae
authors.forename: Chikao
authors.initials: C
authors.lastname: Yasunaga
keywords: Acute renal failure; Cell-free and concentrated ascites reinfusion therapy; Refractory ascites; Renal transplantation; Spontaneous bacterial peritonitis