Abstract
Background and Aims: Hepatic hydrothorax is an uncommon complication of portal hypertension. We sought to evaluate the safety and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) in these patients with symptomatic and refractory hepatic hydrothorax. Methods: Twenty four patients who underwent TIPS, between January 2001 and December 2009 for refractory hydrothorax were studied. Clinical, laboratory and procedural data were noted. Outcomes were recorded as responders or non-responders. Data patterns were examined by Chi-square test, t-test and Kaplan– Meier analysis. Results: Patients included 14 men and ten women; Child–Pugh class B, 16 patients; Child–Pugh class C, 8 patients. The mean age at TIPS creation was 60.4 years (s.d. 9.4). Mean pre-TIPS creatinine was 0.9 (s.d. 0.3) and mean model for end stage liver disease (MELD) score was 15.3 (s.d. 4.9). The mean preand post-TIPS portosystemic gradients were 17.7 (s.d. 5.2) mmHg and 7.4 (2.6) mmHg. There was technical success in all patients. In 19 patients covered stents were used and in 5 patients bare stents were used. Data was incomplete in one patient. Clinical response after TIPS was seen in 73.9% (17/23) patients. Median survival of the study group was 295 days (range 10–1280). The short term survival rates at 30 and 90 days were 95.6% and 82.6% respectively. The long term survival rates both at 1 and 3 years is 73.9%. Univariate and multivariate analysis showed clinical response (P = 0.01, HR 2.7 [95%CI 1.4–5.8]) was significantly and independently associated with overall survival. The 30 day mortality rate was 4.3%. Post TIPS new onset or worsening of encephalopathy was seen in 40 % of patients. Conclusion: TIPS is a relatively safe and effective method of controlling refractory hepatic hydrothorax. Clinical response after TIPS is associated with longer survival. Early mortality after TIPS may be minimized by proper selection of patients with low MELD and near normal renal functions.
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