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

Abstract

BACKGROUND/AIMS:

Hepatic hydrothorax is a complication of portal hypertension secondary to ascites. In this study, we investigated retrospectively the effects of the transjugular intrahepatic portosystemic shunt (TIPS) on hepatic 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, pleurocenteses 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 10 +/- 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 urinary sodium excretion (22 +/- 29 v. 89 +/- 43 mmol/24 h) (P< 0.05). Two patients developed severe hepatic encephalopathy requiring shunt occlusion. Hydrothorax 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 these patients, shunt revision resulted in a secondary response rate of 82.3%. The 1-year survival was 64%. Both hydrothorax response and survival showed 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 treatment and other standard interventions to bridge the time to transplantation. Patients older than 60 years have a poor response and short survival.

• Authors: V Siegerstetter, P Deibert, A Ochs, M Olschewski, H E Blum, M Rössle
• Journal: European journal of gastroenterology & hepatology (Eur J Gastroenterol Hepatol) Vol. 13 Issue 5 Pg. 529-34 (May 2001) ISSN: 0954-691X [Print] England
• PMID: 11396532 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Diuretics

Topics

• Adult
• Aged
• Ascites (complications)
• Diuretics (therapeutic use)
• Female
• Follow-Up Studies
• Humans
• Hydrothorax (drug therapy, etiology, metabolism, surgery)
• Male
• Middle Aged
• Portasystemic Shunt, Transjugular Intrahepatic (methods)
• Recurrence
• Retrospective Studies
• Severity of Illness Index
• Survival Analysis
• Time Factors
• Treatment Outcome