Cell‐free concentrated ascites reinfusion therapy enables removal of extracellular vesicles and circulating immune complexes in ascites

Abstract Introduction Cell‐free and concentrated ascites reinfusion therapy (CART) is used for ascites in decompensated cirrhosis and malignant tumors. We investigated extracellular vesicles (EVs) and circulating immune complexes (CICs) as potential inflammatory inducers in ascites and verified whether they can be removed through CART treatment. Methods Ascites from 10 patients, including those with cancer, undergoing CART were analyzed. We compared the inflammatory inducers in untreated ascites, ascites processed using AHF‐MO (conventional CART filter), and those filtered with EC20W (double‐filtration plasmapheresis filter). A cell‐based reporter assay measured biological activity. Results AHF‐MO significantly lowered EV and CIC levels along with physiological activity in the treated ascites. EC20W was superior in terms of EV removal but showed no significant difference from AHF‐MO in CIC removal. AHF‐MO showed a greater reduction in physiological activity. Conclusion The CART process with AHF‐MO effectively removes EVs and CICs, reducing physiological activity and demonstrating its safety in ascites treatment.