Transjugular intrahepatic portosystemic shunts and liver transplantation in patients with refractory hepatic hydrothorax

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 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.