CART for ascites accumulation and dialysis difficulty after hepatic cyst fenestration and bilateral nephrectomy in ADPKD: a case report

Hepatomegaly with hepatic cysts constitutes a common extrarenal manifestation of autosomal dominant polycystic kidney disease (ADPKD), often resulting in mass effects and occasionally necessitating cyst fenestration to alleviate abdominal distension. Nonetheless, persistent cyst fluid leakage as a postoperative complication frequently leads to refractory ascites, for which treatment options are limited. In this report, we present a 62-year-old female patient with ADPKD undergoing maintenance hemodialysis. She received bilateral nephrectomy and hepatic cyst fenestration to mitigate abdominal distension. Postoperatively, she developed ascites accumulation and recurrent intradialytic hypotension, impairing effective ultrafiltration. The ascites proved unresponsive to conservative management, and analysis indicated hepatic cyst fluid leakage, with elevated CA19-9 levels in the ascitic fluid. Repeated ultrafiltration and abdominal paracentesis failed to produce sustained benefits. Subsequently, she underwent two sessions of cell-free and concentrated ascites reinfusion therapy (CART), which successfully reduced her ascites. Over the subsequent four months, her serum albumin levels increased, intradialytic hypotension resolved, and the ascites subsided without recurrence, thus permitting the repair of an inguinal hernia identified at referral. This case exemplifies that CART constitutes an effective therapeutic modality for managing ascites accumulation resulting from hepatic cyst leakage following fenestration in patients with ADPKD.