Transjugular intrahepatic portosystemic stent shunt for medically refractory hepatic hydrothorax: A systematic review and cumulative meta-analysis

Table 2 Characteristics of 6 studies evaluating the effectiveness of transjugular intrahepatic portosystemic stent shunt in patients with refractory hepatic hydrothorax

Ref.	Methods and patients	Outcomes/complications	Remarks
Gordon et al[14]	Retrospective chart review of 24 consecutive patients with medically RHH	Post-TIPSS response was categorized as complete, partial, or absent	11 patients had variceal bleeding > 4 wk before TIPSS
	Post-TIPSS patients underwent Doppler US studies every 3 to 6 mo	Mean change in HVPG	Stent revision if decreased flow noted
	Mean follow-up was 7.2 mo (range, 0.25-49.0 mo)	TIPSS patency was assessed by change in CTP score, survival, and new or worsened HE	5 failures were CTP C
	Patients with infection were excluded		12 patients had medically RHH; the rest of the 9 patients had TIPSS and RHH as a secondary indication with the primary indication being intractable ascites (n = 7) and gastric varices (n = 2)
Jeffries et al[24]	Retrospective chart review of 12 consecutive patients with medically RHH	Post-TIPSS response at ≤ 1 or > 1 mowas categorized as complete, partial, or absent	Immediate pre- and post-TIPSS prophylactic antibiotics given
	Post-TIPSS, patients had Doppler US studies every 3 mo	TIPSS-related complications: ≤ 30 and > 30 d	Shunt thrombosis or decreased velocities requiredangioplastic revision
	Mean follow-up was 173 d (range, 7-926 d)	New-onset or worsened HE survival	4 patients had shunt revisions
	Patients with heart failure, HCC, alcoholic hepatitis, or intrinsic renal disease were excluded	Mean change in HVPG	Patients who died or underwent transplant ≤ 30 d after TIPSS were classified as nonresponders to TIPSS
Siegerstetter et al[26]	Retrospective chart review of 40 consecutive patients with medically RHH	Post-TIPSS response was categorized as complete, partial, or absent	8 patients had no ascites; RHH was diagnosed by intraperitoneal methylene blue injection or technetium-Tc-99
	Post-TIPSS, patients had Doppler US studies at 4 wk, then every 3 mo	Predictors of survival:	2 stent size reductions due to chronic HE
	Mean (SD) follow-up was 14 mo	Mean change in HVPG
	[14 (range, 1-54 mo)]	New-onset or worsened HE
	Patients with infection were excluded	CTP score improvement
		Survival at 1 yr
Spencer et al[27]	Retrospective chart review of 21 consecutive patients with medically RHH	30-d mortality	Prophylactic antibiotics administered
	Post-TIPSS, patients had Doppler US studies at 1, 3, and 6 mo, then every 6 mo	Post-TIPSS complications: Early ( ≤ 30 d) or late(> 30 d)	Radiographic and clinical response
	Mean follow-up was 223 d	New-onset or worsened HE	TIPSS placement 100% successful
	Patients with severe right-sided heart failure and patients with PVT with cavernous transformation were excluded	Post-TIPSS response was categorized as complete, partial, or absent	1 patient with a partial response was weaned off oxygen due to decreased pleural fluid
		Mean change in HVPG
		Cumulative survival
Wilputte et al[28]	Retrospective chart review of 28 consecutive patients with medically RHH	Mean change in HVPG	Stent revised for stenosis, obstruction, or relapsing RHH
	Post-TIPSS, patients had Doppler US at 24 h and at 1, 2, 3, 6, 9, and 12 mo, then every 6 mo	30-d mortality post-TIPSS	Patients who underwent transplant were censored at surgery date
	Mean (SD) follow-up was 358 d (121 d); 3 patients were excluded due to grade 3 HE, HCC, cardiopulmonary disease, and infection	Response to TIPSS was categorized as complete, partial, and absent	6 patients required TIPSS revision
			2 patients had TIPSS reduction due to intractable HE
			Both covered and uncovered stents were used
Dhanasekaran et al[23]	Retrospective chart review of 73 consecutive patients with medically RHH	Post-TIPSS response at 1 mo and 6 mo was categorized as complete, partial, or absent	TIPSS catheterization used if stenosis suspected or RHH reaccumulated
	Patients had Doppler US every 3 mo for 12 mo, then annually	Evaluated predictors of response to TIPSS	Angioplasty performed, if needed
	Patients with heart failure, pulmonary disease, infection, severe HE, portal vein thrombosis, and multiple hepatic cysts were excluded	Assessed for new or worsening HE	Uncovered and covered stents used
		Mean change in HVPG
		Overall and 30-d mortality

CTP: Child-Turcotte-Pugh; HE: Hepatic encephalopathy; HCC: Hepatocellular carcinoma; HVPG: Hepatic venous pressure gradient; PVT: Portal vein thrombosis; RHH: Refractory hepatic hydrothorax; TIPSS: Transjugular intrahepatic portosystemic shunt; US: Ultrasound.