Patients being treated for liver disease at the Royal Free Hospital are having their lives transformed thanks to a simple pump that is implanted in the abdomen.
A liver transplant is often the only option for patients with severe alcohol-related liver disease and around 4,000 people in the UK die of the condition every year.
However, new technology being trialled at the Royal Free has given some patients with liver disease or cirrhosis a new lease on life. The ground-breaking alfapump controls the debilitating symptoms of liver failure and, if patients abstain from drinking alcohol, it can allow the liver to partially recover.
When patients suffer from liver disease the liver and kidneys stop working properly and fluid stops being exchanged within the cells in the way it should. This leads to ascites – an excess of fluid which gathers in the abdomen.
There is no way for this fluid to be removed from the body naturally and up to 15 litres of it can gather around patients’ abdominal organs. Ascites can make patients look pregnant, as well as being painful and taking away the appetite, making patients weak and leading to malnutrition. These patients may have to make weekly or monthly trips to the hospital in order to have the fluid drained from their abdomen.
However the alfapump, which is produced by the Swiss medical devices company Sequana Medical, provides a simple solution to ascites and experts believe it may allow the liver time to recover if further injury is prevented.
The device, which is implanted beneath the skin of the abdomen, is smaller than an iPod and works by pumping fluid from the abdomen into the bladder, where it is removed from the body naturally through urination. Once the symptoms of liver disease are reduced or eliminated, the liver has a better chance of recovery, as long as patients abstain from drinking alcohol.
Michael Beckett, 49, from Portsmouth, had the alfapump implanted last August and his life has been transformed.
Michael admits he had always been a heavy drinker. “I drank after work with colleagues and have always liked a drink,” he said. “I started drinking more when I got divorced and then even more when I was made redundant.”
In 2011 he began to feel unwell and when he visited the doctor he was diagnosed with alcohol-related liver disease. Even though he stopped drinking straight away, the damage had already been done. Michael’s liver was failing to work properly and shortly afterwards he started having his ascites drained.
“I had a huge belly and tiny arms and legs. I wasn’t eating and I was tired all of the time,” explained Michael. “I had to go to the Queen Alexandra Hospital in Portsmouth to have the fluid drained – sometimes I had 14 litres of fluid in my belly.
“I was referred to liver experts at the Royal Free in 2012 and I might have needed a liver transplant because my ascites wasn’t being controlled. Then the doctors there said I could be eligible to be part of this new trial, which would mean I may not need a transplant if things got better.”
Michael had the pump fitted in August last year and since then his health has been given a huge boost. Controlling the symptoms, combined with the fact Michael was not drinking alcohol, has allowed his liver to repair itself and his health seems to be on the mend.
“I am eating more, I have got more energy,” said Michael. “I can really be involved in my sons’ lives. I can be an active father to them, which I couldn’t have been before. I have really been able to kick the drink and I don’t think about drinking any more. I’m so pleased with how things have gone.”
Professor Rajiv Jalan, professor of hepatology at UCL’s institute for liver and digestive health at the Royal Free, is the doctor running the trials.
He has 16 patients currently involved in the study at the Royal Free, with 44 patients are in the process of being enrolled in hospitals across Europe.
“This is a halting treatment,” Professor Jalan explained. “If you can halt the symptoms and prevent further liver injury by stopping drinking alcohol the liver might be able to regenerate. This pump is also about improving the quality of life for patients. We are still waiting for the results to find out whether we can say that the pump can allow liver function to improve, but with Michael all of the signs are very positive.”
Professor Jalan said the pump removes around 10-15ml of fluid from the abdomen every 15 minutes and at its maximum capacity the pump can remove four litres of fluid every day. Because of the pump Michael no longer has a large amount of fluid collecting around his stomach and he no longer needs to go to hospital to have his abdomen drained.
Patients can use a special device to recharge the battery, which needs to be done for about 15 minutes daily and the pump is switched off at night.
Professor Jalan added: “Although the results of the study are not all in, what we have seen so far is that, if patients stop abusing alcohol, there is hope – even for those with severe cirrhosis.”