title: Automated low flow pump system for the treatment of refractory ascites: a single-center experience.
abstract: BACKGROUND
  Ascites is a common complication of liver cirrhosis and represents the main cause of hospitalization among patients with cirrhosis. First-line therapy for those patients is the use of diuretics and dietary sodium restriction. However, 10 % of patients per year become therapy refractory to diuretic treatment with the need of repeated high-volume paracentesis or transjugular intrahepatic portosystemic shunt (TIPS). For these patients, an automated pump system (Alfapump/Sequana Medical) was developed. Here, we describe our single-center experience of ten consecutively implanted pump systems.
  
  
  METHODS
  Between 08/13 and 11/14, ten Alfapump systems were implanted in patients with refractory ascites all suffering from liver cirrhosis. Those patients were treated as a bridge to transplant (4/10) or as an end-stage therapy (6/10). Median follow-up was 165 days (23-379 days).
  
  
  RESULTS
  Postimplant, the need of paracentesis could be markedly reduced to a mean of 0.45 (0-4/month) per month. In eight patients, paracentesis was not needed after implantation of the pump system. The median daily output volume was 1000 ml/day (450-2000 ml/day). Prerenal insufficiency was a recurrent complication in the postoperative period.
  
  
  CONCLUSIONS
  The Alfapump system is a useful system in the treatment of patients suffering from therapy refractory ascites. However, due to the high level of comorbidities, careful patient selection and postoperative monitoring are required.
authors.affiliation: Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, L.M., University of Munich, Campus Großhadern, Marchioninistrasse 15, 81375, München, Deutschland, Germany. michael.thomas@med.uni-muenchen.de.
authors.forename: M N
authors.initials: MN
authors.lastname: Thomas
authors.affiliation: Department of Medicine II, Klinikum Großhadern, L.M., University of Munich, Munich, Germany.|Liver Center Munich, Klinikum Großhadern, L.M., University of Munich, Munich, Germany.
authors.forename: G H
authors.initials: GH
authors.lastname: Sauter
authors.affiliation: Department of Medicine II, Klinikum Großhadern, L.M., University of Munich, Munich, Germany.|Liver Center Munich, Klinikum Großhadern, L.M., University of Munich, Munich, Germany.
authors.forename: A L
authors.initials: AL
authors.lastname: Gerbes
authors.affiliation: Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, L.M., University of Munich, Campus Großhadern, Marchioninistrasse 15, 81375, München, Deutschland, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Stangl
authors.affiliation: Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, L.M., University of Munich, Campus Großhadern, Marchioninistrasse 15, 81375, München, Deutschland, Germany.
authors.forename: T S
authors.initials: TS
authors.lastname: Schiergens
authors.affiliation: Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, L.M., University of Munich, Campus Großhadern, Marchioninistrasse 15, 81375, München, Deutschland, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Angele
authors.affiliation: Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, L.M., University of Munich, Campus Großhadern, Marchioninistrasse 15, 81375, München, Deutschland, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Werner
authors.affiliation: Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, L.M., University of Munich, Campus Großhadern, Marchioninistrasse 15, 81375, München, Deutschland, Germany.|Liver Center Munich, Klinikum Großhadern, L.M., University of Munich, Munich, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Guba
mesh_terms: D001201:Ascites / Q000209:etiology* / Q000628:therapy*; D005260:Female; D006801:Humans; D007677:Kidney Function Tests; D007902:Length of Stay / Q000706:statistics & numerical data; D008103:Liver Cirrhosis / Q000150:complications*; D008111:Liver Function Tests; D008297:Male; D061646:Operative Time; D019152:Paracentesis; D018579:Patient Selection; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D011183:Postoperative Complications / Q000453:epidemiology; D019736:Prostheses and Implants; D016896:Treatment Outcome
keywords: Alfapump; Ascites; Liver cirrhosis