Treatment of refractory ascites with an automated low flow ascites pump in patients awaiting liver transplantation

Abstract

BackgroundFor patients with liver cirrhosis awaiting liver transplantation who suffer from refractory ascites (RA), standard treatment consists of repeated large volume paracentesis. The automated low-flow ascites-pump (alfapump) offers an innovative treatment alternative for patients with RA, if TIPSS is contraindicated or ineffective. This study addresses the feasibility of alfapump treatment in patients awaiting liver transplantation. MethodsBetween 2012 and 2018, patients listed for liver transplantation who were treated with an alfapump were included in this retrospective single centre study. ResultsOf 22 patients listed for liver transplantation and treated with an alfapump, 14 were finally transplanted. Alcohol-related liver disease was the most common aetiology for liver cirrhosis (n = 11), followed by hepatitis C, hepatitis B and NASH. Mean age at listing was 56.3 years and 68.2% of patients were male. The average daily ascites volume pumped by the device was 1076 ml. During transplant surgery, no alfapump-related complications occurred. The alfapump was removed at the end of the transplant procedure in eight patients and left in place in three patients for up to 104 days, whereas three patients had the pump removed prior to the transplantation. Overall survival was significantly better in patients that were finally transplanted (log-rank p < 0.0001). Five patients (22.7%) required at least one alfapump-related re-intervention. ConclusionTreatment with an alfapump in patients on the liver transplant waiting list with refractory ascites is feasible. The alfapump did not affect the transplant procedure and was explanted in most patients at the end of the transplant surgery.