Large-volume cell-free and concentrated ascites reinfusion therapy improves venous flow in patients with liver cirrhosis

Purpose Hemodynamic change after total paracentesis was investigated because it might lead to various complications. Although cell-free and concentrated ascites reinfusion therapy (CART) is safer and more effective than total paracentesis in theory, hemodynamic change after CART has been never reported. And previous studies did not mention hemodynamics of the venous system. Methods We investigated the hemodynamic change, including that of the venous system, before and after CART using color Doppler ultrasonography and fast Fourier transform analysis. Twenty-eight patients with tensive cirrhotic ascites underwent ultrasonography the day before and after total volume CART. The diameter and velocity of the main, right, and left portal vein; inferior vena cava (IVC); and right renal vein were measured using ultrasonography. Results A total of 11.8 +/- 4.4 L of ascites (range 3.6-20.9 L) was filtered and concentrated to 0.85 +/- 0.40 L (range 0.36-1.50 L). The diameter of the IVC increased from median 13.5 +/- 5.4 mm (range 4-25 mm) to 18.5 +/- 4.1 mm (range 7-29 mm) (p = 0.007). The diameter of the right segmental renal vein significantly increased after KM-CART [from 5.0 +/- 1.0 (4-8) mm to 7.0 +/- 2.0 (3-10) mm] (p = 0.011). Hemodynamic change of the portal venous system was not significant. The time to the next CART in patients with an IVC diameter >= 20 mm and < 20 mm was 86 days and 20.5 days (p = 0.035), respectively. Conclusion Tensive ascites results in venous congestion in patients with cirrhotic ascites. CART improved venous flow, but it did not change the hemodynamics of the portal venous system.