Treatment of refractory hepatic hydrothorax with transjugular intrahepaticportosystemic shunt: long-term results in 40 patients

Background/aims Hepatic hydrothorax is a complication of portal hypertensio n secondary to ascites, in this study, we investigated retrospectively the effects of the transjugular intrahepatic portosystemic shunt (TIPS) on hepa tic hydrothorax refractory to diuretic treatment. Methods Forty patients (Child-Pugh class B, 24 patients; Child-Pugh class C , 16 patients) with hydrothorax refractory to diuretic treatment, pleurocen teses or pleurodesis were included. The TIPS implantation was successful in all patients, who were then followed for 16 +/- 14 months (range 1 day-54 months). Results TIPS reduced the portosystemic pressure gradient from 26 +/- 6 to 1 0 +/- 5 mmHg. In the 17 patients whom we followed for 12 months or longer, improvements were found for the Child-Pugh score (8.6 +/- 1.8 v. 6.7 +/- 1. 5), serum albumin concentration (3.1 +/- 0.5 v. 3.6 +/- 0.5 g/l), and urina ry sodium excretion (22 +/- 29 v. 89 +/- 43 mmol/24 h) (P < 0.05). Two pati ents developed severe hepatic encephalopathy requiring shunt occlusion. Hyd rothorax improved in 82% of patients and resolved in 71% of patients. Fifty per cent of patients developed shunt insufficiency within 7 +/- 9 months, contributing to a probability of relapse-free 1-year survival of 35%. In th ese patients, shunt revision resulted in a secondary response rate of 82.3% . The 1-year survival was 64%. Both hydrothorax response and survival showe d a significant inverse correlation with age over 60 years (P < 0.01 and P < 0.003, respectively) but not with other biomedical variables. Conclusion TIPS is effective for hydrothorax refractory to diuretic treatme nt and other standard interventions to bridge the time to transplantation. Patients older than 60 years have a poor response and short survival. Eur J Gastroenterol Hepatol 13:529-534 (C) 2001 Lippincott Williams & Wilkins.