Stirnimann, Guido; Berg, Thomas; Spahr, Laurent; Zeuzem, Stefan; McPherson, Stuart; Lammert, Frank; Storni, Federico; Banz, Vanessa; Babatz, Jana; Vargas, Victor; Geier, Andreas; Engelmann, Cornelius; Herber, Adam; Trepte, Claudia; Capel, Jeroen; De Gottardi, Andrea (2022). Final Safety and Efficacy Results from a 106 Real-World Patients Registry with an Ascites-Mobilizing Pump. Liver international, 42(10), pp. 2247-2259. Wiley 10.1111/liv.15337
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BACKGROUND & AIMS
Patients with cirrhotic refractory ascites ineligible for transjugular intrahepatic shunt (TIPSS) have limited treatment options apart from repeated large volume paracentesis. The alfapump® is an implantable device mobilizing ascites from the peritoneal cavity to the bladder, from where it can be excreted. The aim of this observational cohort study was to prospectively investigate safety and efficacy of the device in a real-world cohort with cirrhotic refractory ascites and contraindications for TIPSS.
METHODS
A total of 106 patients received an implant at twelve European centers and were followed up for up to 24 months. Complications, device deficiencies, frequency of paracentesis, clinical status and survival were recorded prospectively.
RESULTS
Approximately half of the patients died on-study, about a quarter were withdrawn due to serious adverse events leading to explant, a sixth were withdrawn due to liver transplant or recovery, and nine completed follow-up. The most frequent causes of on-study death and complication-related explant were progression of liver disease and infection. The device reduced the requirement for large volume paracentesis significantly, with more than half of patients not having required any post-implant. Survival benefits were not observed. Device-related reinterventions were predominantly caused by device deficiencies. A post-hoc comparison of the first 50 vs. the last 50 patients enrolled revealed a decreased reintervention rate in the latter, mainly related to peritoneal catheter modifications.
CONCLUSIONS
The device reduced paracentesis frequency in a real-world setting. Technical complications were successfully decreased by optimization of management and device modification (NCT01532427).
Item Type: |
Journal Article (Original Article) |
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Division/Institute: |
04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine > Hepatology 04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine > Visceral Surgery |
UniBE Contributor: |
Stirnimann, Guido, Storni, Federico Lorenzo, Banz Wüthrich, Vanessa, De Gottardi, Andrea |
ISSN: |
1478-3231 |
Publisher: |
Wiley |
Language: |
English |
Submitter: |
Pubmed Import |
Date Deposited: |
13 Jun 2022 08:12 |
Last Modified: |
12 Jun 2023 00:25 |
Publisher DOI: |
10.1111/liv.15337 |
PubMed ID: |
35686702 |
Uncontrolled Keywords: |
TIPSS ascites, alfapump cirrhosis large volume paracentesis |
BORIS DOI: |
10.48350/170583 |
URI: |
https://boris.unibe.ch/id/eprint/170583 |
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