Transjugular intrahepatic portosystemic shunt (TIPS) placement: A comparison of outcomes between patients with hepatic hydrothorax and patients with refractory ascites

Purpose

To compare the outcomes in patients who had transjugular intrahepatic portosystemic shunts (TIPS) placed for hepatic hydrothorax with those who had it placed for refractory ascites.

Materials and methods

One hundred and forty-seven patients who underwent TIPS placement for refractory fluid accumulation were included. There were 97 men and 50 women with a mean age of 56.1 ± 9.7 (SD) years (range: 25–81 years). Of those, 32 patients (32/147; 21.8%) had refractory hepatic hydrothorax and 115 (115/147; 78.2%) had refractory ascites. Electronic medical records were reviewed for all patients to determine demographic, procedural related, and outcomes data. Both traditional analysis and a propensity score matching analysis were performed, to account for differences in baseline laboratory values, etiology of cirrhosis, age, and average number of paracenteses/thoracenteses per week. Survival analysis was also performed to compare post-TIPS survival by indication.

Results

Differences in response rates, in terms of fluid accumulation reductions, at 1, 3, and 6 months were not significant (P = 0.19, P = 0.33, and P = 0.28, respectively). A successful propensity score matching was made between 24 hepatic hydrothorax and 46 ascites patients. After propensity score matching the response rates at 1, 3, and 6 months remained non-significant (P = 0.3, P = 0.71, and P = 0.78 respectively). No differences in mean overall survival were found between hepatic hydrothorax patients (672 days) and ascites patients (1224 days) (P = 0.15).

Conclusion

The clinically relevant outcomes of improvement in fluid accumulation and overall survival do not appear to be significantly different in patients who have TIPS placed for refractory hepatic hydrothorax or and those who have TIPS placed for ascites.