Infusion of cell-free, concentrated ascites in a patient with polycystic disease

Abstract

Ascites was successfully infused in a patient with intractable ascites after filtration and concentration of the fluid. A 64-year-old female, who had had bilateral nephrectomy for a polycystic kidney 20 years earlier and another for recurrent pyelonephritis 14 years later, had been maintained by hemodialysis. The paracentesis done for marked abdominal distention yielded clear, straw-like fluid, which contained more than 4g/100ml protein and few cell fractions.
Despite frequent paracentesis, the ascitic retention did not decrease, and hypotension, hypoproteinemia and occasional vomiting continued. A large amount of plasma protein fraction was infused without effect.
Ascitic fluid was filtered with a cellulose diacetate hollow fiber 0.2μ pore in diameter and concentrated with a polyacrylonitrile hollow fiber, using an Autoascit II (Asahi Medical Co., Ltd.). A MEDICUT (Argyle Co., Ltd.) 16G side hole needle was chosen for paracentesis. The protein of the fluid was raised to the concentration of 10g/100ml This concentrated fluid was then intravenously infused during ascites drainage or stored at -80°C for later use.
The patient's general feeling of well-being was improved and abdominal distention decreased by this technique. No side effects were noted. Thirteen thousand four hundred ml of ascites were drained by these four infusion procedures, while it had been possible to remove only 6, 800ml of ascites during the six months before infusion. The plasma protein fraction requirement decreased from 3, 250ml to 0ml Systolic blood pressure rose and abdominal girth decreased significantly, but levels of serum protein showed no difference.
Filtration, concentration and infusion of ascites was effective for improving the patient's discomfort and saving the use of plasma protein fraction in a case of intractable ascitic retention.