Ascitic ultrafiltration and reinfusion of protein concentrate is of value in selected patients and is, in general, well tolerated. Patients with massive ascites and an unsatisfactory response to diuretic therapy are most suitable, but those with ascitic infection, pulmonary oedema, and terminal liver disease are excluded. Although two of our patients had malignant ascites, reinfusion is not recommended for such patients.
Persistent pulmonary oedema was a contributory cause of death in two patients, and was attributed to reinfusion. Intraperitoneal haemorrhage may occur from a perforated collateral vein and close observation of patients must be continued after the peritoneal catheter has been removed.
A clogged ultrafilter was cleared with urokinase, and further studies of this are indicated.
After ultrafiltration about half the patients were satisfactorily controlled with diuretic drugs, although there is no evidence that reinfusion produces a sustained improvement in diuretic responsiveness.