Management of hepatic hydrothorax is difficult and oftenHepatic hydrothorax is a rare complication of portal results in iatrogenic complications. Repeated thoracentesis, hypertension. Conservative therapy may be successful chest tube thoracostomy, pleurodesis, and peritoneovenous but refractory hepatic hydrothorax is not uncommon.shunt have been used with varying degrees of success. HowManagement of refractory hydrothorax is usually inefever, there have been many reports of failure and complicafective and can result in a worsened clinical status.tion with each of these procedures. [7][8][9] The only definitive Transjugular intrahepatic portosystemic shunts (TIPS) treatment is liver transplantation. lower portal pressure and have been used in the treatTransjugular intrahepatic portosystemic shunt (TIPS) rement of refractory ascites. The aim of this study was duces portal pressure and has been reported to improve the to determine the efficacy of TIPS in the treatment of control of refractory ascites in cirrhotic patients. [10][11][12] The goal symptomatic refractory hepatic hydrothorax. A TIPS was placed in 24 consecutive cirrhotic patients with of this study was to determine if the reduction in portal pressymptomatic refractory hepatic hydrothorax. Five pa-sure by TIPS improved the control of symptomatic hepatic tients (20.8%) were Child's/Pugh class B and 19 (79.2%) hydrothorax. Additionally, we evaluated the effect of TIPS in were class C. All had undergone multiple thoracenteses these patients on the Child's-Pugh class and the need for and were hypoalbuminemic. Mean follow-up was 7.2 orthotopic liver transplantation. The Child's-Pugh score improved in 7 (58.3%) of these 12candidates. All acceptable alcoholic liver transplantation candidates patients and two patients improved from class C to class were considered to have been abstinent for at least 6 months. A. These two patients no longer require liver transAll patients had clinical, laboratory, and radiologic evidence of plantation. This study shows that TIPS can be effective liver disease and portal hypertension. All patients had persistent in the management of symptomatic, refractory hepatic right-sided hydrothorax despite sodium and fluid restriction and the hydrothorax. Clinical and laboratory improvement may use of the maximum tolerable doses of diuretics. Diuretic use was be seen and liver transplantation may become unneces-limited by progressive azotemia, electrolyte imbalance, and hypotension. Infectious causes of hydrothorax were ruled out by fluid analysary. (HEPATOLOGY 1997;25:1366-1369.) sis and culture. Only patients with pulmonary symptoms, such as dyspnea and orthopnea, were enrolled in the study. All patients had Hepatic hydrothorax is the accumulation of ascitic fluid undergone multiple thoracenteses before transfer to our hospital. in the pleural space. It occurs in 0.4% to 12.2% of cirrhotic Five patients had chest tubes in place draining at least 4 L/d. Atpatients.1-3 The precise pathogenetic mechanisms remain un-tempts to remove or clamp ...

No abstract

Iron overload is associated with hepatocellular carcinoma in patients with end-stage liver disease, suggesting a possible carcinogenic or cocarcinogenic role for iron in chronic liver disease.

TIPS placement appears to be effective as a primary treatment of patients with cirrhosis and severe ascites.

4586 Background: For HCC pts undergoing LT, loco-regional treatment as a "bridge" is standard. The best bridging modality is unclear. SBRT is safe and effective when used in pts with advanced HCC. We prospectively compared SBRT to TACE as a bridge for HCC pts undergoing LT. Methods: From 9/2014-10/2019, 60 pts within Milan Criteria with CTP Class A/B8 cirrhosis were consented. 54 pts were randomized to TACE vs. SBRT. TACE pts (n =30) were scheduled to receive 2 treatments one month apart utilizing DEBDOX beads. TACE pts were hospitalized after each TACE. Pts receiving SBRT (n =24) received a median total dose of 45Gy delivered over 5 fractions using fiducials. Mean liver dose, Veff, and NTCP determined prescription dose. Pts were assessed by using mRECIST criteria at 2 months and every 3 months thereafter until LT or death. Toxicity and QOL were assessed before treatment, during treatment, two weeks post-treatment, and then every three months using the PIQ-6 Pain Impact Questionnaire and the SF-36v2 Health Survey. The 1° endpoint was time to recurrent or residual dz. Secondary endpoints were toxicity, pathologic response, radiologic response, number of subsequent treatments, cost, and QOL. 50 pts are evaluable for review. Results: See table. Conclusions: For early stage HCC patients with CTP Class A/B liver cirrhosis, SBRT appears as effective as TACE at controlling HCC prior to LT, may engender less toxicity, and eliminates the need for hospitalization. A larger multi-center trial is ongoing. Clinical trial information: NCT02182687. [Table: see text]