Indwelling Pleural Catheters in Hepatic Hydrothorax: A Single-Center Series of Outcomes and Complications.
BACKGROUND
Treatment of hepatic hydrothorax (HH) generally involves sodium restriction, diuretics, and serial thoracentesis. In more advanced cases, transjugular intrahepatic portosystemic shunt and liver transplantation may be required. Previously, indwelling tube drainage has been avoided due to concerns regarding high complication rates and overall poor outcomes. Recently, indwelling pleural catheters (IPCs) have been proposed as a novel treatment option for HH.


METHODS
This study was a retrospective review of patients who had undergone IPC placement for HH over a 10-year period at a large liver transplant referral center. We tracked outcomes, including complication rates and liver transplantation, as well as biomarkers of nutritional status.


RESULTS
Sixty-two patients underwent IPC placement between 2007 and 2017, with 33 IPCs (53%) placed as a bridge to liver transplantation. Complications were recorded in 22 patients (36%); empyema was the most common, diagnosed in 10 patients (16.1%). Ten patients evaluated for liver transplantation underwent successful transplantation following IPC placement. There were statistically significant decreases in both BMI and serum albumin levels following IPC placement.


CONCLUSIONS
IPCs represent a potential treatment for refractory HH and should be used with caution in patients eligible for liver transplantation. Ideally, IPC use for these patients would be evaluated by a multidisciplinary team. IPC use may lead to small decreases in BMI and serum albumin levels in patients over time.
['Kniese|Christopher|C|', 'Diab|Khalil|K|', 'Ghabril|Marwan|M|', 'Bosslet|Gabriel|G|']
D000368:Aged D002408:Catheters, Indwelling D002423:Cause of Death D015331:Cohort Studies D016724:Empyema, Pleural D005260:Female D006801:Humans D006876:Hydrothorax D017093:Liver Failure D016031:Liver Transplantation D008297:Male D008875:Middle Aged D011183:Postoperative Complications D011379:Prognosis D012189:Retrospective Studies D018570:Risk Assessment D015996:Survival Rate D000069258:Thoracentesis D016896:Treatment Outcome
indwelling pleural catheter hepatic hydrothorax liver transplant empyema