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Refractory ascites (RA) is a frequent complication of liver cirrhosis. Its prognosis is poor, with a 6-month transplantation-free survival (TFS) rate of only 50%. Liver transplantation (LT) is the treatment of choice for RA but its access remains limited and the waiting time on the LT list may be lengthy for eligible patients. In selected patients, the placement of a TIPS (transjugular intrahepatic portosystemic shunt) improves TFS and reduces the need for paracentesis. Iterative large-volume paracentesis is the first-line treatment for RA but is associated with a decrease in quality of life due to repeated hospitalizations. The alfapump® is an implantable device that can be recharged by induction. It comprises a pump implanted subcutaneously in the abdominal wall, connected to a catheter located in the peritoneal cavity and to another located in the bladder, thus allowing the transfer of ascites and its removal via the urinary tract. The alfapump® is effective for reducing the need for paracentesis and for improving quality of life and nutritional status. However, no impact on survival has been demonstrated to date. The most frequent complications are kidney failure, bacterial infections, and dysfunction of the device. In the absence of absolute contraindication (i.e., loculated ascites, urinary outflow tract obstruction, contraindication to general anesthesia, poor short-term prognosis), alfapump® is an alternative treatment to be considered for patients not eligible for TIPS, who may or may not be on the LT list.