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DOI: 10.1055/s-0044-1786828
Outcome of Transjugular Intrahepatic Portosystemic Shunt in Patients with Cirrhosis and Refractory Hepatic Hydrothorax: A Systematic Review and Meta-analysis
Abstract
Background Around 5% of patients with cirrhosis of the liver develop hepatic hydrothorax (HH). For patients with refractory HH (RHH), transjugular intrahepatic portosystemic shunt (TIPS) has been investigated in small studies. Hence, the present meta-analysis aimed to summarize the current data on the outcome of TIPS in patients with RHH.
Methods From inception through June 2023, MEDLINE, Embase, and Scopus were searched for studies analyzing the outcome of TIPS in RHH. Clinical response, adverse events (AEs), mortality, and shunt dysfunction were the primary outcomes assessed. The event rates with their 95% confidence interval were calculated using a random-effects model.
Results A total of 12 studies (n = 466) were included in the final analysis. The pooled complete and partial response rates were 47.2% (35.8–58.5%) and 25.5% (16.7–34.3%), respectively. The pooled incidences of serious AEs and post-TIPS liver failure after TIPS in RHH were 5.6% (2.1–9.0%) and 7.6% (3.1–12.1%), respectively. The pooled incidences of overall hepatic encephalopathy (HE) and severe HE nonresponsive to standard treatment after TIPS in RHH were 33.2% (20.0–46.4%) and 3.6% (0.4–6.8%), respectively. The pooled 1-month and 1-year mortality rates were 14.0% (8.3–19.6%) and 42.0% (33.5–50.4%), respectively. The pooled incidence of shunt dysfunction after TIPS in RHH was 24.2% (16.3–32.2%).
Conclusion RHH has a modest response to TIPS in patients with cirrhosis, with only half having a complete response. Further studies are required to ascertain whether early TIPS can improve the outcome of patients with cirrhosis and HH.
Keywords
portal hypertension - cirrhosis - pleural effusion - hepatic hydrothorax - transjugular intrahepatic portosystemic shuntPublication History
Article published online:
18 May 2024
© 2024. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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References
- 1 Roussos A, Philippou N, Mantzaris GJ, Gourgouliannis KI. Hepatic hydrothorax: pathophysiology diagnosis and management. J Gastroenterol Hepatol 2007; 22 (09) 1388-1393
- 2 Badillo R, Rockey DC. Hepatic hydrothorax: clinical features, management, and outcomes in 77 patients and review of the literature. Medicine (Baltimore) 2014; 93 (03) 135-142
- 3 Strauss RM, Martin LG, Kaufman SL, Boyer TD. Transjugular intrahepatic portal systemic shunt for the management of symptomatic cirrhotic hydrothorax. Am J Gastroenterol 1994; 89 (09) 1520-1522
- 4 Xiol X, Guardiola J. Hepatic hydrothorax. Curr Opin Pulm Med 1998; 4 (04) 239-242
- 5 Alberts WM, Salem AJ, Solomon DA, Boyce G. Hepatic hydrothorax. Cause and management. Arch Intern Med 1991; 151 (12) 2383-2388
- 6 Emerson PA, Davies JH. Hydrothorax complicating ascites. Lancet 1955; 268 (6862) 487-488
- 7 Johnston RF, Loo RV. Hepatic hydrothorax; studies to determine the source of the fluid and report of thirteen cases. Ann Intern Med 1964; 61: 385-401
- 8 Lieberman FL, Hidemura R, Peters RL, Reynolds TB. Pathogenesis and treatment of hydrothorax complicating cirrhosis with ascites. Ann Intern Med 1966; 64 (02) 341-351
- 9 Rubinstein D, McInnes IE, Dudley FJ. Hepatic hydrothorax in the absence of clinical ascites: diagnosis and management. Gastroenterology 1985; 88 (1 Pt 1): 188-191
- 10 Krok KL, Cárdenas A. Hepatic hydrothorax. Semin Respir Crit Care Med 2012; 33 (01) 3-10
- 11 Rajesh S, Philips CA, Betgeri SS. et al. Transjugular intrahepatic portosystemic shunt (TIPS) placement at index portal hypertensive decompensation (anticipant TIPS) in cirrhosis and the role of early intervention in variceal bleeding and ascites. Indian J Gastroenterol 2021; 40 (04) 361-372
- 12 Page MJ, McKenzie JE, Bossuyt PM. et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021; 372 (71) n71
- 13 Giri S, Kale A, Shukla A. Efficacy and safety of transjugular intrahepatic portosystemic shunt creation for Budd-Chiari syndrome: a systematic review and meta-analysis. J Vasc Interv Radiol 2022; 33 (11) 1301-1312.e13
- 14 Dariushnia SR, Haskal ZJ, Midia M. et al; Society of Interventional Radiology Standards of Practice Committee. Quality improvement guidelines for transjugular intrahepatic portosystemic shunts. J Vasc Interv Radiol 2016; 27 (01) 1-7
- 15 Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003; 327 (7414) 557-560
- 16 Gordon FD, Anastopoulos HT, Crenshaw W. et al. The successful treatment of symptomatic, refractory hepatic hydrothorax with transjugular intrahepatic portosystemic shunt. Hepatology 1997; 25 (06) 1366-1369
- 17 Jeffries MA, Kazanjian S, Wilson M, Punch J, Fontana RJ. Transjugular intrahepatic portosystemic shunts and liver transplantation in patients with refractory hepatic hydrothorax. Liver Transpl Surg 1998; 4 (05) 416-423
- 18 Spencer EB, Cohen DT, Darcy MD. Safety and efficacy of transjugular intrahepatic portosystemic shunt creation for the treatment of hepatic hydrothorax. J Vasc Interv Radiol 2002; 13 (04) 385-390
- 19 Dhanasekaran R, West JK, Gonzales PC. et al. Transjugular intrahepatic portosystemic shunt for symptomatic refractory hepatic hydrothorax in patients with cirrhosis. Am J Gastroenterol 2010; 105 (03) 635-641
- 20 Mitchell JE, Aggarwal A, Hanouneh IA, Atreja A, Zein NN. Transjugular intrahepatic portosystemic shunt is an effective treatment modality in the management of refractory hepatic hydrothorax in patients with liver cirrhosis. Gastroenterology 2011; 140: S954-S955
- 21 Young S, Bermudez J, Zhang L, Rostambeigi N, Golzarian J. Transjugular intrahepatic portosystemic shunt (TIPS) placement: a comparison of outcomes between patients with hepatic hydrothorax and patients with refractory ascites. Diagn Interv Imaging 2019; 100 (05) 303-308
- 22 Harimoto H, Kanazawa H, Narahara Y. et al. Transjugular intrahepatic portosystemic shunt for the treatment of refractory hepatic hydrothorax. Kanzo 2020; 61 (08) 399-409
- 23 Siegerstetter V, Deibert P, Ochs A, Olschewski M, Blum HE, Rössle M. Treatment of refractory hepatic hydrothorax with transjugular intrahepatic portosystemic shunt: long-term results in 40 patients. Eur J Gastroenterol Hepatol 2001; 13 (05) 529-534
- 24 Wilputte JY, Goffette P, Zech F, Godoy-Gepert A, Geubel A. The outcome after transjugular intrahepatic portosystemic shunt (TIPS) for hepatic hydrothorax is closely related to liver dysfunction: a long-term study in 28 patients. Acta Gastroenterol Belg 2007; 70 (01) 6-10
- 25 Campos S, Gomes D, Sofia C. Transjugular intrahepatic portosystemic shunt in refractory hydrothorax - a contribution to an unexplored indication. Eur J Gastroenterol Hepatol 2016; 28 (06) 661-666
- 26 Jindal A, Mukund A, Kumar G, Sarin SK. Efficacy and safety of transjugular intrahepatic portosystemic shunt in difficult-to-manage hydrothorax in cirrhosis. Liver Int 2019; 39 (11) 2164-2173
- 27 German M, Lee A, Hristov A. et al. TIPS effectively treats refractory hepatic hydrothorax: a multi-center U.S. retrospective study of 1,260 patients. Am J Transplant 2019; 19 (S3): 564-565
- 28 Patel RK, Chandel K, Tripathy TP, Mukund A. Complications of transjugular intrahepatic portosystemic shunt (TIPS) in the era of the stent graft - what the interventionists need to know?. Eur J Radiol 2021; 144: 109986
- 29 Schindler P, Heinzow H, Trebicka J, Wildgruber M. Shunt-induced hepatic encephalopathy in TIPS: current approaches and clinical challenges. J Clin Med 2020; 9 (11) 3784
- 30 Gou X, Jia W, He C. et al. Hepatic hydrothorax does not increase the risk of death after transjugular intrahepatic portosystemic shunt in cirrhosis patients. Eur Radiol 2023; 33 (05) 3407-3415
- 31 Perkins JD. Liver function determines success of transjugular intrahepatic portosystemic shunt in treating hepatic hydrothorax. Liver Transpl 2008; 14 (03) 382-383