Cell-free concentrated Ascites reinfusion therapy for refractory Ascites associated with alcoholic liver cirrhosis

A 58-year-old man was admitted to the hospital because of ascites due to alcohol-related cirrhosis, which was refractory to salt-restricted diet and diuretics. He showed no improvement even after the administration of albumin preparation and developed hepatic encephalopathy due to intravascular volume depletion. Ascites decreased when cell-free concentrated ascites reinfusion therapy (CART) was introduced, without developing hepatic encephalopathy. After introducing temperance guidance, the serum albumin level increased from 2.4 g/d/to 3.6 g/d/ and the Child-Pugh score improved from 12 points to 6 points. CART is defined in the clinical practice guideline for liver cirrhosis in Japan that it is as effective as total paracentesis but would not improve the prognosis. However, it was considered from this case that CART is useful for refractory ascites with decompensated cirrhosis because CART do not occur hepatic encephalopathy.