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.
