{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T18:38:16Z","timestamp":1783535896215,"version":"3.55.0"},"reference-count":24,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","license":[{"start":{"date-parts":[[2017,4,24]],"date-time":"2017-04-24T00:00:00Z","timestamp":1492992000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1"},{"start":{"date-parts":[[2017,4,24]],"date-time":"2017-04-24T00:00:00Z","timestamp":1492992000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Liver Transpl"],"published-print":{"date-parts":[[2017,5]]},"abstract":"<jats:p>The <jats:bold>alfa<\/jats:bold>pump system has been proposed as a new treatment for the management of refractory ascites. The system removes ascites from the peritoneal cavity to urinary bladder, producing a continuous low\u2010volume paracentesis. The aim of the study is to investigate the effects of treatment with the <jats:bold>alfa<\/jats:bold>pump\u2122 system on kidney and circulatory function in patients with cirrhosis and refractory ascites. This was a prospective study including 10 patients with cirrhosis and refractory ascites. Primary outcomes were changes in glomerular filtration rate (GFR), as assessed by isotopic techniques, and changes in circulatory function assessed by arterial pressure, cardiac output, and activity of vasoconstrictor systems. Secondary outcomes were the need for large\u2010volume paracentesis and adverse events. Follow\u2010up was 1 year. GFR decreased significantly from 67\u2009mL\/minute\/1.73\u2009m<jats:sup>2<\/jats:sup> (41\u201090\u2009mL\/minute\/1.73\u2009m<jats:sup>2<\/jats:sup>) at baseline to 45\u2009mL\/minute\/1.73\u2009m<jats:sup>2<\/jats:sup> (36\u201074\u2009mL\/minute\/1.73\u2009m<jats:sup>2<\/jats:sup>) at month 6 (<jats:italic toggle=\"yes\">P<\/jats:italic>\u2009=\u20090.04). Mean arterial pressure and cardiac output did not change significantly; however, there was a marked increase in plasma renin activity and norepinephrine concentration (median percent increase with respect to baseline +191% and 59%, respectively). There were 68 episodes of complications of cirrhosis in 8 patients during follow\u2010up, the most frequent being acute kidney injury. In conclusion, treatment with <jats:bold>alfa<\/jats:bold>pump\u2122 system was associated with marked activation of endogenous vasoconstrictor systems and impairment of kidney function. The chronological relationship observed between kidney impairment and vasoconstrictor systems activation after device insertion suggests a cause\u2010effect relationship, raising the possibility that treatment with <jats:bold>alfa<\/jats:bold>pump impairs effective arterial blood volume mimicking a postparacentesis circulatory dysfunction syndrome. In this context, the potential role of albumin in counteracting these effects should be investigated in future studies. <jats:italic toggle=\"yes\">Liver Transplantation 23 583\u2013593 2017 AASLD<\/jats:italic>.<\/jats:p>","DOI":"10.1002\/lt.24763","type":"journal-article","created":{"date-parts":[[2017,3,20]],"date-time":"2017-03-20T09:04:52Z","timestamp":1490000692000},"page":"583-593","source":"Crossref","is-referenced-by-count":43,"title":["Effects of alfapump\u2122 system on kidney and circulatory function in patients with cirrhosis and refractory ascites"],"prefix":"10.1097","volume":"23","author":[{"given":"Elsa","family":"Sol\u00e0","sequence":"first","affiliation":[{"name":"Liver Unit, Hospital Cl\u00ednic,University of Barcelona,Barcelona,Spain"},{"name":"Institut d\u2019Investigacions Biom\u00e8diques August Pi i Sunyer (IDIBAPS),Barcelona,Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Hep\u00e1ticas y Digestivas (CIBEREHD),Madrid,Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Santiago","family":"Sanchez\u2010Cab\u00fas","sequence":"additional","affiliation":[{"name":"HBP Surgery and Liver Transplantation Unit,University of Barcelona,Barcelona,Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ezequiel","family":"Rodriguez","sequence":"additional","affiliation":[{"name":"Liver Unit, Hospital Cl\u00ednic,University of Barcelona,Barcelona,Spain"},{"name":"Institut d\u2019Investigacions Biom\u00e8diques August Pi i Sunyer (IDIBAPS),Barcelona,Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Hep\u00e1ticas y Digestivas (CIBEREHD),Madrid,Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Elia","sequence":"additional","affiliation":[{"name":"Liver Unit, Hospital Cl\u00ednic,University of Barcelona,Barcelona,Spain"},{"name":"Institut d\u2019Investigacions Biom\u00e8diques August Pi i Sunyer (IDIBAPS),Barcelona,Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Hep\u00e1ticas y Digestivas (CIBEREHD),Madrid,Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raquel","family":"Cela","sequence":"additional","affiliation":[{"name":"Liver Unit, Hospital Cl\u00ednic,University of Barcelona,Barcelona,Spain"},{"name":"Institut d\u2019Investigacions Biom\u00e8diques August Pi i Sunyer (IDIBAPS),Barcelona,Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Hep\u00e1ticas y Digestivas (CIBEREHD),Madrid,Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebeca","family":"Moreira","sequence":"additional","affiliation":[{"name":"Liver Unit, Hospital Cl\u00ednic,University of Barcelona,Barcelona,Spain"},{"name":"Institut d\u2019Investigacions Biom\u00e8diques August Pi i Sunyer (IDIBAPS),Barcelona,Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Hep\u00e1ticas y Digestivas (CIBEREHD),Madrid,Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisa","family":"Pose","sequence":"additional","affiliation":[{"name":"Liver Unit, Hospital Cl\u00ednic,University of Barcelona,Barcelona,Spain"},{"name":"Institut d\u2019Investigacions Biom\u00e8diques August Pi i Sunyer (IDIBAPS),Barcelona,Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Hep\u00e1ticas y Digestivas (CIBEREHD),Madrid,Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jordi","family":"S\u00e1nchez\u2010Delgado","sequence":"additional","affiliation":[{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Hep\u00e1ticas y Digestivas (CIBEREHD),Madrid,Spain"},{"name":"Hospital Parc Taul\u00ed,Sabadell,Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nuria","family":"Ca\u00f1ete","sequence":"additional","affiliation":[{"name":"Hospital del Mar,Barcelona,Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuel","family":"Morales\u2010Ruiz","sequence":"additional","affiliation":[{"name":"Biochemistry and Molecular Genetics Department, Hospital Cl\u00ednic, University of Barcelona,Barcelona,Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco","family":"Campos","sequence":"additional","affiliation":[{"name":"Nuclear Medicine Department, Hospital Cl\u00ednic,Barcelona,Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaume","family":"Balust","sequence":"additional","affiliation":[{"name":"Anesthesiology Department, Hospital Cl\u00ednic,Barcelona,Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M\u00f3nica","family":"Guevara","sequence":"additional","affiliation":[{"name":"Liver Unit, Hospital Cl\u00ednic,University of Barcelona,Barcelona,Spain"},{"name":"Institut d\u2019Investigacions Biom\u00e8diques August Pi i Sunyer (IDIBAPS),Barcelona,Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Hep\u00e1ticas y Digestivas (CIBEREHD),Madrid,Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan Carlos","family":"Garc\u00eda\u2010Valdecasas","sequence":"additional","affiliation":[{"name":"HBP Surgery and Liver Transplantation Unit,University of Barcelona,Barcelona,Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pere","family":"Gin\u00e8s","sequence":"additional","affiliation":[{"name":"Liver Unit, Hospital Cl\u00ednic,University of Barcelona,Barcelona,Spain"},{"name":"Institut d\u2019Investigacions Biom\u00e8diques August Pi i Sunyer (IDIBAPS),Barcelona,Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Hep\u00e1ticas y Digestivas 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