LAUSR

ALFAPUMP SYSTEM PARACENTESIS Treatment options for patients with refractory ascites are limited to liver transplantation and insertion of transjugular intrahepatic portosystemic stent-shunt, in a selected group of patients. All other patients require repeated large volume paracentesis (LVP). alfapump is a novel, fully implantable, automated, low flow system that automatically moves ascitic fluid into the urinary bladder. Bureau et al. describe the results of the first, multicenter, European study comparing alfapump with LVP. The trial data confirm that insertion of the alfapump is associated with significant reduction in the need for LVP, improvements in the quality of life and nutritional state. The incidence of acute kidney injury was higher in the patients treated with alfapump, but this did not impact negatively on survival. Further improvements in the technology and regular albumin infusions may allow the alfapump to emerge as an important new therapeutic for this group of patients.