REINFUSION OF CONCENTRATED ASCITIC FLUID VERSUS TOTAL PARACENTESIS - A RANDOMIZED PROSPECTIVE TRIAL

We compared the efficacy and safety of apheresis and reinfusion of con centrated ascites (APCA) versus total paracentesis plus intravenous al bumin (PARA) in a prospective trial on cirrhotic patients with tense a scites. Twenty-four patients were randomized to either ARCA (N = 12) o r 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 of the procedures were 2.7 +/- 1.0 (ARCA) vs 2.2 +/- 1.1 (PARA) hr, w ith removal of 8.8 +/- 3.5 (ARCA) and 6.9 +/- 3.4 (PARA) liters of asc ites 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 a fter ARCA, with an increase in prothrombin time (P = 0.005) and serum FSP (P = 0.02). No significant changes in renal function, serum albumi n, or plasma and urinary electrolytes were shown. Plasma renin activit y increased after PARA (P = 0.02) and plasma atrial natriuretic factor increased after ARCA (P = 0.008), although no differences were observ ed 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 concentrate d ascites are as safe and effective as total paracentesis with albumin infusion for the treatment of tense ascites in cirrhotic patients.