Prospective study comparing human albumin vs. reinfusion of ultrafiltrate-ascitic fluid after total paracentesis in cirrhotic patients with tense ascites

Although, total paracentesis associated with human albumin substitution has shown to be a rapid, effective and safe treatment of diuretic refractory a scites in advanced liver cirrhosis, it implies high costs and has a limited availability. Therefore an alternative procedure the reinfusion of concent rated ascites has gained popularity in recent years (Smart et al. 1990; Gra zioto et al. 1997). It was the aim of the study to compare human albumin su bstitution vs. reinfusion of ascitic-ultrafiltrate after total paracentesis . 35 patients with cirrhosis and tense ascites received total paracentesis as sociated with either human albumin (5-8 g/l ascites) (= group A) or reinfus ion of an ascitic-ultrafiltrate fluid by means of hemofiltration technique (= group B). The mean volume of ascites removed was 9.41 (2.1-20.0) in grou p A and 11.41 (6.5-21.0) in group B. No significant differences in serum el ectrolytes, liver and renal function, coagulation profiles and hormones of the renin-angiotensin-aldosterone system were observed during hospitalizati on. In both groups sodium excretion increased significantly. 43 % of the pa tients in group B developed pyrexia and chill after reinfusion of the ascit ic-ultrafiltrate fluid. In one patient an anaphylactic bronchospasm occurre d requiring IUC-treatment. The treatment cost in case of human albumin were 326.-DM vs. 290.-DM for each patient treated with ascitic-ultrafiltrate fl uid reinfusion. The probabilities of hospital readmission and survival were similar in both groups during followup. The results indicate that i.v. infusion of ascitic-ultrafiltrate fluid is a s effective as total paracentesis and albumin infusion in case of diuretic refractory ascites. However, according to the costs of instruments and staf f and due to the significant allergic reactions caused by ascitic fluid it cannot be considered as a real alternative to albumin substitution.