Hepatic
hydrothorax is a relatively infrequent but potentially serious complication of
cirrhosis resulting from the accumulation of ascitic fluid in the chest cavity. Medical management is initially directed at controlling
ascites formation, but invasive therapeutic procedures may be required if symptoms persist. The aim of this study was to report on the long-term efficacy and safety of transjugular intrahepatic
portosystemic shunt (
TIPS) placement to reduce
portal hypertension in 12 consecutive subjects with refractory hepatic
hydrothorax. Most subjects had evidence of advanced
cirrhosis of varying causes (Child-Pugh class A, 1; B, 5; C, 6). Mean subject age was 54 years, and subjects were followed up for a mean of 173 days (range, 7-926 days). The portosystemic pressure gradient after
TIPS was reduced to <12 mmHg in all cases. Periprocedural morbidity was noted in 2 subjects, and 30-day survival after
TIPS placement was 75%. Overall, 58% of subjects experienced either a complete or partial response following
TIPS placement. Subject response did not correlate with age, baseline
creatinine clearance, or Child-Pugh score. Cumulative subject survival was 42%, and 4 of the 5 long-term survivors required eventual
liver transplantation. Subject age >65 years was associated with early mortality after
TIPS placement, but this trend was not statistically significant. All 4 subjects undergoing
liver transplantation required perioperative pleural fluid drainage, but only 1 subject has experienced recurrent effusion. We conclude that
TIPS may be a safe and effective temporizing treatment for carefully selected patients with refractory hepatic
hydrothorax. However, patient survival is limited after
TIPS and is primarily determined by availability of
liver transplantation.