Liver Cirrhosis
Conditions
Brief summary
The study will be a single centre, open-label trial. The patients will have a diagnosis of refractory ascites and will meet specified inclusion/exclusion criteria Informed consent will be obtained from all patients. All patients will have an alfapump surgically inserted and in addition will receive 8g of salt-poor Human Albumin Solution (20%) per 1 litre of Ascites drained. This Intravenous administration will be intermittent (every month) and will take place as a day patient. Patients will also receive standard of care, which may include, but is not limited to, administration of diuretics, paracentesis and consideration for orthotopic liver transplantation.
Detailed description
The study will be a single centre, open-label trial. The patients will have a diagnosis of refractory ascites and will meet specified inclusion/exclusion criteria Informed consent will be obtained from all patients. All patients will have an alfapump surgically inserted and in addition will receive 8g of salt-poor Human Albumin Solution (20%) per 1 litre of Ascites drained. This Intravenous administration will be intermittent (every 2 weeks) and will take place as a day patient. Patients will also receive standard of care, which may include, but is not limited to, administration of diuretics, paracentesis and consideration for orthotopic liver transplantation. The primary objective of the study is to assess whether intermittent human albumin replacement in accordance with large volume paracentesis guidelines (8g/L ascites drained) can prevent the development of renal dysfunction at the 3-month assessment. This would potentially guide the clinical use of the alfapump system. The secondary objectives of the study are to address the objectives of a previous alfa pump study /sub study, to allow comparison of the proposed study data to that generated in the previous studies. These will be measured at the 1-month and 3-month time points.
Interventions
DEVICEalfapump
Implantation of alfapump
DRUGsalt-poor Human Albumin solution
Patients implanted with an alfapump will receive intermittent salt-poor human albumin solution
Sponsors
Sequana Medical N.V.
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Males and non-pregnant females (determined by serum pregnancy test) ≥ 18 years of age. Women of childbearing age must be prepared to use at least 1 effective (≤1% failure rate) method of contraception during the course of the study 2. Cirrhosis of the liver defined by histological and/or clinical, and/or radiological criteria 3. Presenting with refractory ascites\* and requiring periodic large volume paracentesis (large volume defined as ≥ 5 L to accord with the clinical guidance of EASL, European Association for the Study of the Liver, which recommends withdrawal of 5 L should precipitate administration of albumin). 4. Capable of giving written informed consent, willing to comply with study procedures and ability to operate the device
Exclusion criteria
1. Gastrointestinal haemorrhage over the last 7 days 2. Renal failure defined as serum creatinine higher than or equal to 2 mg/dl 3. Severe coagulopathy defined as prothrombin time greater than 40% more than Upper Limit of Normal 4. Platelet count of less than 40,000 / μL unless platelet therapy is given at the time of surgery 5. Clinical Evidence of recurrent bacterial peritonitis, defined as 2 or more episodes over the last 6 months or a single episode within the last 2 weeks 6. Clinical evidence of recurrent urinary infections, defined as 2 or more episodes over the last 6 months or a single episode within the last 2 weeks 7. Clinical evidence of loculated ascites 8. Advanced hepatocellular carcinoma, defined as exceeding Milan criteria 9. Obstructive uropathy, residual urinary volume exceeding 100ml, or any bladder anomaly which might contraindicate implantation of the device 10. Concurrently implanted with any other Active Implantable Medical Device, including, but not limited to cardiac pacemaker or cardiovertering defibrillator 11. Pregnant females or females anticipating pregnancy during study period 12. Patients currently enrolled in another interventional clinical study 13. Other concomitant disease or condition likely to significantly decrease life expectancy or present anaesthetic risk (e.g., moderate to severe congestive heart failure) 14. Known presence of human immunodeficiency virus (HIV) 15. Immuno-modulatory treatment (including azathioprine, methotrexate, anti-TNF therapies) used within last 4 months 16. Known or suspected hepatic or extra hepatic malignancy, unless adequately treated or in complete remission for ≥ 3 years 17. BMI\>40 presenting a risk for surgery and tunnelled lines 18. Patients with contraindications for general anesthesia
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| To assess whether intermittent human albumin replacement in accordance with large volume paracentesis guidelines (8g/L ascites drained) can prevent the development of renal dysfunction, measured by serum creatinine | 3 months | Measured by serum creatinine. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Assessment of cirrhosis- related complications, measured by Incidence of specific cirrhosis-related complications | 3 months | Measured by Incidence of specific cirrhosis-related complications |
| Assessment of the Overall Survival at 3 months, measured by survival | 3 months | Measured by overall survival at 3 months |
| Assessment of impact on nutrition, measured by changes in body weight | 3 months | Measured by changes in the nutritional status of the patient |
| Assessment of impact on nutrition, measured by changes in circumference of arm | 3 months | Measured by changes in the nutritional status of the patient |
| Assessment of impact on nutrition, measured by changes in tricipital skinfold | 3 months | Measured by changes in the nutritional status of the patient |
| Assessment of circulatory haemodynamics, measured by non-invasive cardiac haemodynamics | 3 months | Measured by non-invasive cardiac haemodynamics |
| Assessment of the need for large volume paracentesis, measured by the overall requirements of paracentesis | 3 months | Measured by the overall requirement for paracentesis |
| Assessment of impact on Systemic Inflammatory Response, measured by CRP | 3 months | Measured by Inflammatory markers |
| Assessment of impact on Systemic Inflammatory Response, measured by cytokines | 3 months | Measured by Inflammatory markers |
| Assessment of impact on Systemic Inflammatory Response, measured by function of the peripheral blood mononuclear cells | 3 months | Measured by Inflammatory markers |
| Assessment of levels of bacterial DNA in serum, measured by presence of bacterial DNA in blood | 3 months | Measured by the presence of bacterial DNA in blood. |
| Assessment of impact on nutrition, measured by changes in handgrip | 3 months | Measured by changes in the nutritional status of the patient |
Countries
United Kingdom
Outcome results
None listed