The hypothesis is that the Alfapump® strategy would be more effective in terms of QALYs generated , and that the cost of Alfapump® device and its implantation will be totally or partially offset by the reduction in the number of evacuating parentheses performed and the reduction in the number of complications in patients with refractory ascites awaiting liver transplantation or not. On the other hand, given the difference in the clinical profiles of these two populations (whether or not they are awaiting transplantation), these two populations will be study separately
Evaluation of the medical-economic impact at 1 year of the two therapeutic strategies: implantation of Alfapump® versus repeated evacuating paracentesis in cirrhotic patients with refractory ascites without scheduled liver transplantation.
Patient with refractory ascites who has had a minimum of 5 paracentesis in the last 3 months.
Patient with an estimated life expectancy of at least 6 months on the day of inclusion.
Patient with contraindication to the application of a TIPS or who has expressed a refusal of the procedure or a non-functional TIPS
Patient affiliated with or in receipt of social security
Local or systemic infection in the month preceding the procedure
Hepatocellular carcinoma with palliative care
MELD Score > 18
Child Pugh C Score > 10