Indwelling Tunneled Pleural Catheters for the Management of Hepatic Hydrothorax: A Pilot Study.
Ann Am Thorac Soc. 2016 Mar 25;
Authors: Chen A, Massoni J, Jung D, Crippin J
RATIONALE: Hepatic hydrothorax is a complication of cirrhosis in which hydrostatic imbalances result in fluid accumulation within the pleural space. While uncommon, this may cause significant morbidity, resulting in dyspnea requiring repeated pleural drainage procedures. Liver transplantation is curative, though is rarely immediately available to qualified patients, presenting the clinical challenge of managing recurrent pleural effusions. Indwelling tunneled pleural catheters have been used to successfully palliate dyspnea associated with recurrent malignant pleural effusions.
OBJECTIVES: This study was performed to evaluate the feasibility of using indwelling tunneled pleural catheters for the management of hepatic hydrothorax.
METHODS: A single center prospective feasibility study was performed to evaluate the use of indwelling tunneled pleural catheters for the management of recurrent hepatic hydrothorax in patients who were eligible for liver transplant evaluation.
MEASUREMENTS AND MAIN RESULTS: Twenty-five indwelling tunneled pleural catheters (ITPC) were placed in 24 patients. The mean number of pleural drainage procedures prior to ITPC placement was 1.9 with no further pleural drainages required in any patient following ITPC placement. Spontaneous pleurodesis occurred in 8/24 patients (33%) with all 8 catheters successfully removed without pleural fluid re-accumulation. Mean time to pleurodesis was 119.2 days. Pleural fluid infection occurred in 4/24 patients (16.7%), requiring catheter removal in 3/4 patients.
CONCLUSIONS: Indwelling tunneled pleural catheters may be successfully and safely used to control symptoms associated with hepatic hydrothorax. The rate of spontaneous pleurodesis that occurs is similar to that observed with ITPC's placed for malignant pleural effusion, though the infection rate may be higher. Clinical trial registered with ClinicalTrials.gov (NCT02595567).
PMID: 27015392 [PubMed - as supplied by publisher]