Alfapump-albumin Replacement Therapy

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