TIPS Effectively Treats Refractory Hepatic Hydrothorax: A Multi-Center U.S. Retrospective Study of 1,260 Patients
1University of Wisconsin, Madison, WI, 2Northwestern University, Chicago, IL, 3University of California, San Francisco, San Francisco, CA, 4University of Florida, Gainesville, FL, 5University of Indiana, Indianapolis, IN, 6University of Arizona, Tucson, AZ, 7University of Chicago, Chicago, IL, 8Scripps Clinic, San Diego, CA, 9Columbia University, New York, NY, 10Stanford University, Palo Alto, CA
Meeting: 2019 American Transplant Congress
Abstract number: 570
Keywords: Liver cirrhosis, Quality of life
Session Information
Session Name: Concurrent Session: Liver: Recipient Selection
Session Type: Concurrent Session
Date: Tuesday, June 4, 2019
Session Time: 4:30pm-6:00pm
Presentation Time: 5:42pm-5:54pm
Location: Room 312
*Purpose: Hepatic hydrothorax (HHT) occurs in 5-10% of patients with cirrhosis. Current literature on the use of transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of HHT is limited to small retrospective studies and case series. We aimed to evaluate the efficacy of TIPS in the setting of HHT in a large, multi-center cohort.
*Methods: A multi-center, retrospective cohort study was conducted of patients with cirrhosis who underwent TIPS between 2010-2015 across 9 tertiary care centers as part of the Advancing Liver Therapeutic Approaches (ALTA) Consortium. Inclusion criteria were: age >18 years (y) and cirrhosis complications as indication for TIPS.
*Results: Of 1,260 TIPS recipients, 132 (11%) received a TIPS for HHT, of which 54 (41%) had refractory ascites as a secondary indication. Most (71%) HHTs were right-sided. Median age was 58y, 50% were male, 70% Caucasian, and 30% Hispanic. Liver disease etiologies were HCV (36%), alcohol (30%), and non-alcoholic fatty liver disease (21%). Pre-TIPS median MELD-Na for the HHT group was 21 (range 7-32), compared to the cohort median MELD-Na of 18 (range 6 – 45). 110 (83%) patients required a thoracentesis (clinically significant [cs]-HHT) within 12 months pre-TIPS, with a median of 2 (range 1-25) procedures. 83 (75%) patients who required at least one thoracentesis pre-TIPS had complete resolution of cs-HHT at 3 months post-TIPS. In those patients who had cs-HHT and clinically significant ascites (requiring at least 1 paracentesis) before TIPS, 78% (47/60) had complete resolution of cs-HHT at 3 months vs 76% (38/50) in those without clinically significant ascites. In 1y following TIPS, only 17 (13%) patients were able to discontinue diuretics. Four patients (3%) required a VATS procedure post-TIPS. Overall survival was comparable between the HHT cohort and overall cohort: 88% vs 86% at 30d, 78% vs 78% at 90d and 61% vs 65% at 1y, respectively. Similarly, TFS was also comparable: 76% vs 80% at 30d, 66% vs 69% at 90d, and 42% vs 53% at 1y, respectively.
*Conclusions: In the largest, multi-center, retrospective cohort of TIPS recipients in the US, we note that TIPS is a safe and effective method of treating HHT in the absence or presence of ascites. A majority (75%) of patients had complete resolution of clinically significant HHT at 3 months post-TIPS. Overall and TFS were similar between those patients receiving TIPS for an indication of HHT versus other indications.
To cite this abstract in AMA style:
German M, Lee A, Hristov A, Said A, Boike J, Ge J, Jest N, Morelli G, Kolli K, Lai J, Desai A, Junna S, Pokhrel B, Couri T, Paul S, Frenette C, Christian-Miller N, Verna E, Rahim U, Goel A, Das A, Pine S, Gregory D, VanWagner L, Spengler E. TIPS Effectively Treats Refractory Hepatic Hydrothorax: A Multi-Center U.S. Retrospective Study of 1,260 Patients [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/tips-effectively-treats-refractory-hepatic-hydrothorax-a-multi-center-u-s-retrospective-study-of-1260-patients/. Accessed May 9, 2025.« Back to 2019 American Transplant Congress