Chest
Original Research: Pulmonary ProceduresIndwelling Tunneled Pleural Catheters for Refractory Hepatic Hydrothorax in Patients With Cirrhosis: A Multicenter Study
Section snippets
Methods
A multi-institution retrospective study of all patients with cirrhosis with HH undergoing IPC placement was performed at the following medical centers: Beth Israel Deaconess Medical Center, Johns Hopkins Medical Center, Lahey Hospital and Medical Center, Mayo Clinic, Vanderbilt University Medical Center, Virginia Commonwealth University Health System, University of North Carolina, and Washington University from January 2010 to December 2016. The institutional review board of all centers
Patient Characteristics
A total of 79 patients were identified from eight institutions (Table 1). All patients were included in the analysis. The mean age ± SD was 60 ± 10.7 years, and 54% of the patients were men. History of failed TIPS was noted in 16 patients (20%). Indication for IPC placement was palliation in 58 patients (73%) and bridge to transplant in 21 patients (27%). Among those with IPC placement as a bridge to liver transplant, 15 patients went on to receive liver transplant. The most common cause of
Discussion
We present, to our knowledge, the first and only multicenter study to examine clinical outcomes related to the placement of IPC for refractory HH in patients with underlying cirrhosis and end-stage liver disease.
The median time to IPC removal within the cohort was 156 days; however, in patients achieving spontaneous pleurodesis, the median time to removal was 55 days. Although the spontaneous pleurodesis rate in our cohort is lower than that seen in the setting of MPE, it is important to note
Conclusions
Management of HH remains a challenging clinical scenario with suboptimal palliative options. Select patients may undergo liver transplant or respond to TIPS; however, a large portion of patients require repeat thoracentesis and hospital visits because of recurrent dyspnea and suffer from poor quality of life. The current study suggests that the use of an IPC in patients with HH may be an overall safe procedure and results in spontaneous pleurodesis in about 30% of patients. Because of the lack
Acknowledgments
Author contributions: S. S. is the guarantor of the paper. S. S. participated in study design, data collection, data analysis, manuscript writing, and manuscript review. N. R. participated in study design, data analysis, and manuscript review. K. H. participated in data collection and manuscript review. R. K. participated in data collection and manuscript review. M. L. participated in data collection and manuscript review. M. A. participated in data collection and manuscript review. C. L.
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Cited by (46)
Pleural Interventions in the Management of Hepatic Hydrothorax
2022, ChestCitation Excerpt :However, in potentially transplantable patients, again it is often an ongoing discussion with the hepatology team about the current impact of HH, how an IPC may help, and the ultimate risks of IPC placement. Although some remain excited about potential IPC-related spontaneous pleurodesis, some authors have cautioned about the likely overestimation of reported pleurodesis rates, because in some studies half of the patients achieving IPC removal did so after liver transplantation.27 Additionally, because the use of IPCs is not without consequence, the ultimate sin would be the development of an IPC-related complication (empyema) that precludes liver transplant—the only intervention with a mortality benefit in this disease.
Indwelling Pleural Catheters
2021, Clinics in Chest MedicineCitation Excerpt :No specific information regarding symptom improvement was provided, but 28% of patients experienced pleurodesis, allowing for IPC removal. However, the observed infection rate in this population was 10% with an associated 2.5% mortality rate.43 Other studies of drainage procedures for patients with hepatic hydrothorax have reported even higher infection rates ranging from 16% with IPCs up to almost 50% with chest tube placement and hospitalization.44,45
Hepatic Hydrothorax and Congestive Heart Failure Induced Pleural Effusion
2021, Clinics in Chest MedicineCitation Excerpt :Indwelling tunneled pleural catheters (IPCs) have shown great palliative benefit for malignant PEs (MPEs), but it was not until 2017 when they were approved by the FDA for non-MPEs.45. Single-center retrospective and prospective data on IPCs in HH show a spontaneous pleurodesis rate of 15% to 33% with a pleural space infection rate of 15% to 33% (Table 1).46–52 In one multicenter retrospective study50 of 79 patients who underwent IPC placement, pleural space infection occurred in 10% of the population with 2.5% mortality secondary to sepsis due to empyema.
Pleurodesis
2021, Encyclopedia of Respiratory Medicine, Second EditionIndwelling pleural catheter infection and colonisation: a clinical practice review
2024, Journal of Thoracic Disease
FUNDING/SUPPORT: The use of the REDCap Database was supported by the Virginia Commonwealth University Center for Clinical and Translational Research, Richmond, Virginia [Grant NIH/NCRR Grant UL 1TR002649].