{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T01:09:01Z","timestamp":1789002541881,"version":"build-2803163510"},"reference-count":29,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,7,12]],"date-time":"2021-07-12T00:00:00Z","timestamp":1626048000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p><jats:bold>Introduction:<\/jats:bold> Liver transplantation is the treatment of choice for decompensated liver disease, and by extension for hepatic hydrothorax. Persistent pleural effusions make it challenging for patients to maintain physiological fitness for transplantation. Indwelling pleural catheters (IPCs) provide controlled pleural fluid removal, including peri-operatively. The immune dysfunction of cirrhosis heightens susceptibility to bacterial infection and concerns exist regarding the sepsis potential from a tunnelled drain.<\/jats:p><jats:p><jats:bold>Method:<\/jats:bold> Six patients were identified who underwent IPC insertion for hepatic hydrothorax before successful liver transplantation, between November 2016 and November 2017.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> All patients had recurrent transudative right sided pleural effusions. Mean age was 49 years (range 24\u201364) and mean United Kingdom Model for End-Stage Liver Disease score was 58. Four patients required correction of coagulopathy before insertion. There were no complications secondary to bleeding. Three patients were taught self-drainage at home of up to 1 litre (L) daily. A protocol was developed to ensure weekly review, pleural fluid culture and drainage of larger volumes in hospital. For every 2\u20133 L of pleural fluid drained, 100 mls of 20% Human Albumin Solution (HAS) was administered. On average an IPC was <jats:italic>in situ<\/jats:italic> for 58 days before surgery and drained 19 L of fluid in hospital. There was a small increase in average BMI (0.2) and serum albumin (2.1 g\/L) at transplantation. There was one episode of stage one acute kidney injury secondary to high volume drainage. No further ascitic or pleural procedures were needed while an IPC was <jats:italic>in situ<\/jats:italic>. One thoracentesis was required after IPC removal. On average IPCs remained <jats:italic>in situ<\/jats:italic> for 7 days post transplantation and drained a further 2 L of fluid. Pleural fluid sampling was acquired on 92% of drainages in hospital. Of 44 fluid cultures, 2 cultured bacteria. Two patients had their IPCs and all other lines removed post transplantation due to suspected infection.<\/jats:p><jats:p><jats:bold>Conclusion:<\/jats:bold> Our case series describes a novel protocol and successful use of IPCs in the management of refractory hepatic hydrothorax as a bridge to liver transplantation. The protocol includes albumin replacement during pleural drainage, regular clinical review and culture of pleural fluid, with the option of self-drainage at home.<\/jats:p>","DOI":"10.3389\/fmed.2021.695977","type":"journal-article","created":{"date-parts":[[2021,7,12]],"date-time":"2021-07-12T05:06:57Z","timestamp":1626066417000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Case Report: Indwelling Pleural Catheter Based Management of Refractory Hepatic Hydrothorax as a Bridge to Liver Transplantation"],"prefix":"10.3389","volume":"8","author":[{"given":"Mayurun","family":"Selvan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah","family":"Collins","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Griffiths","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Gelson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jurgen","family":"Herre","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,7,12]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"271","DOI":"10.1111\/j.1365-2036.2004.02081.x","article-title":"Review article: hepatic hydrothorax","volume":"20","author":"Cardenas","year":"2004","journal-title":"Aliment Pharmacol Ther."},{"key":"B2","doi-asserted-by":"publisher","first-page":"03","DOI":"10.1055\/s-0032-1301729","article-title":"Hepatic hydrothorax","volume":"33","author":"Krok KL","year":"2012","journal-title":"Semin Respir Crit Care Med."},{"key":"B3","doi-asserted-by":"publisher","first-page":"227","DOI":"10.1055\/s-2007-1007200","article-title":"Hepatic hydrothorax","volume":"17","author":"Strauss","year":"1997","journal-title":"Semin Liver Dis."},{"key":"B4","doi-asserted-by":"publisher","first-page":"33","DOI":"10.5604\/01.3001.0010.7533","article-title":"Hepatic hydrothorax","volume":"17","author":"Lv","year":"2018","journal-title":"Ann Hepatol."},{"key":"B5","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1097\/MD.0000000000000025","article-title":"Hepatic hydrothorax: clinical features, management, and outcomes in 77 patients and review of the literature","volume":"93","author":"Badillo","year":"2014","journal-title":"Medicine."},{"key":"B6","doi-asserted-by":"publisher","first-page":"2288","DOI":"10.1111\/j.1572-0241.1998.00639.x","article-title":"Detection of diaphragmatic defect as the cause of severe hepatic hydrothorax with magnetic resonance imaging","volume":"93","author":"Zenda","year":"1998","journal-title":"Am J Gastroenterol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1159\/000346996","article-title":"Evidence-based review of the management of hepatic hydrothorax","volume":"86","author":"Singh","year":"2013","journal-title":"Respiration."},{"key":"B8","doi-asserted-by":"publisher","first-page":"201","DOI":"10.7861\/clinmedicine.15-2-201","article-title":"Management of patients with decompensated cirrhosis","volume":"15","author":"Harrison","year":"2015","journal-title":"Clin Med."},{"key":"B9","doi-asserted-by":"publisher","first-page":"672","DOI":"10.1111\/j.1432-2277.2005.00116.x","article-title":"Liver transplantation in patients with hepatic hydrothorax","volume":"18","author":"Xiol","year":"2005","journal-title":"Transpl Int."},{"key":"B10","doi-asserted-by":"publisher","first-page":"318627","DOI":"10.1155\/2012\/318627","article-title":"Improving survival in decompensated cirrhosis","volume":"2012","author":"Mukerji","year":"2012","journal-title":"Int J Hepatol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"959","DOI":"10.1136\/thoraxjnl-2013-204563","article-title":"Indwelling pleural catheters for non-malignant effusions: a multicentre review of practice","volume":"69","author":"Bhatnagar","year":"2014","journal-title":"Thorax"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1385","DOI":"10.1016\/j.jhep.2014.08.010","article-title":"Cirrhosis-associated immune dysfunction: distinctive features and clinical relevance","volume":"61","author":"Albillos","year":"2014","journal-title":"J Hepatol."},{"key":"B13","doi-asserted-by":"publisher","first-page":"252","DOI":"10.1136\/gut.2007.131730","article-title":"Selection of patients for liver transplantation and allocation of donated livers in the UK","volume":"57","author":"Neuberger","year":"2008","journal-title":"Gut."},{"key":"B14","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1378\/chest.126.1.142","article-title":"Outcome analysis of cirrhotic patients undergoing chest tube insertion","volume":"126","author":"Liu","year":"2004","journal-title":"Chest."},{"key":"B15","doi-asserted-by":"publisher","first-page":"582","DOI":"10.1007\/s12072-009-9136-z","article-title":"Outcomes of patients with chest tube insertion for hepatic hydrothorax","volume":"3","author":"Orman","year":"2009","journal-title":"Hepatol Int."},{"key":"B16","doi-asserted-by":"publisher","first-page":"5872068","DOI":"10.1155\/2017\/5872068","article-title":"The outcome of thoracentesis versus chest tube placement for hepatic hydrothorax in patients with cirrhosis: a nationwide analysis of the national inpatient sample","volume":"2017","author":"Ridha","year":"2017","journal-title":"Gastroenterol Res Pract."},{"key":"B17","doi-asserted-by":"publisher","first-page":"330","DOI":"10.1159\/000490001","article-title":"Repeat thoracentesis in hepatic hydrothorax and non-hepatic hydrothorax effusions: a case-control study","volume":"96","author":"Shojaee","year":"2018","journal-title":"Respiration."},{"key":"B18","doi-asserted-by":"publisher","first-page":"641","DOI":"10.1111\/jgh.14842","article-title":"Management of hepatic hydrothorax and effect on length of stay, mortality, cost, and 30-day hospital readmission","volume":"35","author":"Sobotka","year":"2020","journal-title":"J Gastroenterol Hepatol."},{"key":"B19","doi-asserted-by":"publisher","first-page":"1366","DOI":"10.1002\/hep.510250611","article-title":"The successful treatment of symptomatic, refractory hepatic hydrothorax with transjugular intrahepatic portosystemic shunt","volume":"25","author":"Gordon","year":"1997","journal-title":"Hepatology."},{"key":"B20","doi-asserted-by":"publisher","first-page":"1797","DOI":"10.4254\/wjh.v7.i13.1797","article-title":"Transjugular intrahepatic portosystemic stent shunt for medically refractory hepatic hydrothorax: a systematic review and cumulative meta-analysis","volume":"7","author":"Ditah","year":"2015","journal-title":"World J Hepatol."},{"key":"B21","doi-asserted-by":"publisher","first-page":"862","DOI":"10.1513\/AnnalsATS.201510-688BC","article-title":"Indwelling tunneled pleural catheters for the management of hepatic hydrothorax. A pilot study","volume":"13","author":"Chen","year":"2016","journal-title":"Ann Am Thorac Soc."},{"key":"B22","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1016\/j.chest.2018.07.001","article-title":"Indwelling pleural catheters in hepatic hydrothorax: a single-center series of outcomes and complications","volume":"155","author":"Kniese","year":"2019","journal-title":"Chest."},{"key":"B23","doi-asserted-by":"publisher","first-page":"546","DOI":"10.1016\/j.chest.2018.08.1034","article-title":"Indwelling tunneled pleural catheters for refractory hepatic hydrothorax in patients with cirrhosis: a multicenter study","volume":"155","author":"Shojaee","year":"2019","journal-title":"Chest."},{"key":"B24","doi-asserted-by":"publisher","first-page":"e918456","DOI":"10.12659\/AOT.918456","article-title":"Perioperative pleural drainage in liver transplantation: a retrospective analysis from a high-volume liver transplant center","volume":"25","author":"Wiering","year":"2020","journal-title":"Ann Transplant."},{"key":"B25","doi-asserted-by":"publisher","first-page":"719","DOI":"10.1002\/hep.510230410","article-title":"Spontaneous bacterial empyema in cirrhotic patients: a prospective study","volume":"23","author":"Xiol","year":"1996","journal-title":"Hepatology."},{"key":"B26","doi-asserted-by":"publisher","first-page":"251","DOI":"10.1016\/j.chest.2018.07.037","article-title":"Indwelling pleural catheter for refractory hepatic hydrothorax: the evidence is still fluid","volume":"155","author":"Walker","year":"2019","journal-title":"Chest."},{"key":"B27","doi-asserted-by":"publisher","first-page":"1651","DOI":"10.1002\/hep.26359","article-title":"Management of adult patients with ascites due to cirrhosis: update 2012","volume":"57","author":"Runyon","year":"2013","journal-title":"Hepatology"},{"key":"B28","doi-asserted-by":"publisher","first-page":"397","DOI":"10.1016\/j.jhep.2010.05.004","article-title":"EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis European Association for the Study of the Liver","volume":"53","year":"2010","journal-title":"J Hepatol"},{"key":"B29","doi-asserted-by":"publisher","first-page":"295153","DOI":"10.1155\/2013\/295153","article-title":"Albumin reduces paracentesis-induced circulatory dysfunction and reduces death and renal impairment among patients with cirrhosis and infection: a systematic review and meta-analysis","volume":"2013","author":"Kwok","year":"2013","journal-title":"Biomed Res Int."}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2021.695977\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,7,12]],"date-time":"2021-07-12T05:06:59Z","timestamp":1626066419000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2021.695977\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7,12]]},"references-count":29,"alternative-id":["10.3389\/fmed.2021.695977"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2021.695977","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,7,12]]},"article-number":"695977"}}