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Related Experiment Video

Updated: Dec 29, 2025

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Improvement in Quality of Life and Decrease in Large-Volume Paracentesis Requirements With the Automated Low-Flow

Florence Wong1, Emily Bendel2, Kenneth Sniderman3

  • 1Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada.

Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
|January 31, 2020
PubMed
Summary

The automated low-flow ascites pump (alfapump) significantly reduces large-volume paracentesis in cirrhosis patients, improving quality of life. This implantable device offers a potential definitive treatment for refractory ascites, especially for those ineligible for TIPS.

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Area of Science:

  • Gastroenterology
  • Hepatology
  • Medical Devices

Background:

  • Ascites is a common complication of cirrhosis, significantly impacting patient quality of life.
  • Recurrent ascites often requires frequent large-volume paracentesis (LVP), which is burdensome and associated with complications.
  • Transjugular intrahepatic portosystemic shunt (TIPS) is an option for refractory ascites, but not all patients are candidates.

Purpose of the Study:

  • To evaluate the safety and efficacy of the automated low-flow ascites pump (alfapump) in managing refractory ascites in cirrhosis patients.
  • To assess the impact of alfapump on the requirement for large-volume paracentesis (LVP) and patient quality of life (QoL).
  • To monitor adverse events and survival rates in patients with alfapump implantation.

Main Methods:

  • A cohort of 30 North American patients with cirrhosis and recurrent ascites, ineligible for TIPS, received an alfapump.
  • QoL was assessed using the Chronic Liver Disease Questionnaire (CLDQ) and Ascites Questionnaire (Ascites Q).
  • Patients were monitored for ascites control, laboratory values, QoL, adverse events, and survival for 12 months post-implantation.

Main Results:

  • The alfapump removed a mean of 230.6 L of ascites per patient over 12 months.
  • Mean LVP frequency decreased dramatically from 2.4/patient/month pre-implantation to 0.2/patient/month post-implantation.
  • All surviving patients reported improved QoL (CLDQ and Ascites Q scores significantly improved; P < 0.001) and better nutritional status (prealbumin increased; P=0.04).

Conclusions:

  • Alfapump implantation significantly reduces LVP frequency and improves QoL in patients with refractory ascites.
  • Common adverse events included bacterial infections, electrolyte abnormalities, and renal complications.
  • Alfapump may serve as a definitive treatment for refractory ascites in cirrhosis, particularly for patients unsuitable for TIPS.