A0477 - Liver Transplant Provides an Added Benefit to Patients with Cirrhosis Who Have Hepatic Hydrothorax

Sunday, October 23, 2022

5:00 PM – 7:00 PM ET

Location: Crown Ballroom

Has Audio

Presenting Author(s)

Karim Osman, MD

Lahey Hospital & Medical Center
Burlington, MA

Karim T. Osman, MD, Amir A. Qamar, MD
Lahey Hospital & Medical Center, Burlington, MA

Introduction: Hepatic hydrothorax (HH) is an important complication of portal hypertension. Treatment is associated with high recurrence, morbidity, and mortality rates. To date, liver transplant (LT) is the best treatment modality. We aim to assess the survival benefit LT has on patients with HH.

Methods: A prospectively maintained cohort of 992 adult patients with cirrhosis, being evaluated for LT at our institution, was retrospectively reviewed from 2015-2020. Primary outcome was death. Cox proportional hazard regression modeling was used to identify associations between covariates and outcomes. The cumulative incidence of outcomes was determined by the Kaplan-Meier method. Furthermore, we calculated the years saved due to LT by comparing patients who were on waiting-list but did not receive a LT with patients who ultimately received a LT. This was done by calculating the area under the Kaplan-Meier curve. This was done individually for both HH and non-HH groups. Subjects were followed from the time of LT evaluation (baseline) till death. Censoring occurred at the time of last follow-up or death.

Results: 115 patients had HH. Thirty-nine (33.91%) patients with HH and 221 (25.20%) patients without HH had died at the end of the follow-up duration. The median survival of patients with HH was 0.66 years as compared to 0.94 years in patients without HH (P-value < 0.001) (Figure A). HH was an independent predictor of mortality even after adjusting for other covariates (Hazard Ratio 1.42, 95% Confidence Interval 1.14-1.79; P-value 0.002) (Table). The expected lifetime of patients with HH who got a LT at one year was 0.98 years while those who did not get a LT was 0.64 years. LT thus offered a survival benefit of 0.34 years at the 1-year time point in patients with HH. Similarly, the expected lifetime of patients without HH who got a LT at one year was 0.96 years while those who did not get a LT was 0.81 years. LT thus offered a survival benefit of 0.15 years at the 1-year time point in patients without HH (Figure B). Thus, patients with HH have an added survival benefit of 0.19 years (0.34-0.15) when transplanted as compared to patients without HH.

Discussion: This is the largest study evaluating the prognostic impact of HH on patients with cirrhosis. HH is an independent predictor of mortality. LT provides an added survival benefit to patients with HH compared to those without HH.

Figure: (A) Kaplan Meier curve comparing survival in patients (B) Survival curves demonstrating the life-time expectancy based on presence/absence of hepatic hydrothorax and transplant status

Variables	Univariable		Multivariable
Variables	HR (95% CI)	P-value	HR (95% CI)	P-value
HH	1.62 (1.31-2.00)	< 0.001	1.42 (1.14-1.79)	0.002
Age	1.00 (1.00-1.01)	0.22
Female	0.94 (0.80-1.11)	0.47
Ascites	1.32 (1.13-1.55)	< 0.001	0.94 (0.77-1.14)	0.54
Hepatic encephalopathy	1.54 (1.31-1.79)	< 0.001	1.39 (1.18-1.64)	< 0.001
Variceal hemorrhage	0.94 (0.75-1.19)	0.61
HCC	0.72 (0.60-0.88)	< 0.001	0.82 (0.67-0.99)	0.04
SBP	1.49 (1.21-1.84)	< 0.001	1.28 (1.01-1.63)	0.04
MELD	1.03 (1.02-1.04)	< 0.001	1.03 (1.02-1.04)	< 0.001

Table: Univariable and multivariable analysis of prognostic factors associated with mortality in the entire cohort

Disclosures:

Karim Osman indicated no relevant financial relationships.

Amir Qamar indicated no relevant financial relationships.

Karim T. Osman, MD, Amir A. Qamar, MD. A0477 - Liver Transplant Provides an Added Benefit to Patients with Cirrhosis Who Have Hepatic Hydrothorax, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.