The outcome after Transjugular Intrahepatic Portosystemic Shunt (TIPS) for hepatic hydrothorax is closely related to liver dysfunction : a long-term study in 28 patients

Objectives : Hepatic hydrothorax is a rare but challenging com- plication of cirrhosis. The Transjugular Intrahepatic Porto- systemic Shunt (TIPS) appears as one of the most successful approach of therapy. Methods : To assess long-term efficacy and safety, we reviewed 28 patients (Child B/C : 43/57%) who underwent TIPS placement for refractory hepatic hydrothorax in our institution between 1992 and 2001. Results : The 30-days mortality was 14%, reaching 25% at 90 days. The one-year survival without liver transplantation was 41.2%. Reduction in the volume of pleural effusion and improve- ment in clinical symptoms was observed in 68% while a complete radiological and echographic disappearance of hydrothorax was documented in 57%. Statistical analysis showed that poor liver function was predictive of mortality and non-response. Of the different liver function parameters and in this small series, the Child-Pugh score was more discriminating than the recently described Mayo risk score. Conclusion : This study shows that TIPS is effective in the treat- ment of hepatic hydrothorax for selected patients. Poor liver func- tion is a strong predictive of bad outcome. (Acta gastroenterol. belg., 2007, 70, 6-10).