Background : In previous studies comparing groups of patients with refractory hydrothorax(RH) and refractory ascites(RA), there was a tendency for higher liver-related deaths in the RH group. Additionally, the number of thoracentesis procedures performed was cumulatively associated with the survival outcomes. Therefore, we aimed to investigate the impact of hydrothorax and ascites on outcomes in liver transplantation recipients.

Methods : A single-center cohort of liver transplant recipients data was merged between June 2006 and December 2022. The RA group included patients who had more than 1000cc of ascites drained during surgery, or those who underwent paracentesis from three months prior to surgery up until one month post-surgery. The RH group encompassed patients who underwent therapeutic thoracentesis for pleural effusion in the three months leading up to the surgery. We conducted a 1:7 propensity score matching(PSM) analysis for the two groups.

Results : Among the matched 206 liver transplantation patients, there were 35 patients(17.0%) with RH and 171 patients(83.0%) with RA. Between the two groups, there was no statistically significant difference in 1-year survival(p=0.073). However, in the 5-year survival analysis, the RH group showed significantly lower mortality rates (p=0.042). Also, there was no difference between the two groups in terms of hospital stay duration or the length of stay in the post-operative intensive care unit stay(p=0.115, p= 0.191, respectively).

Conclusions : Our study reveals that patients with refractory hydrothorax exhibit significantly reduced survival rates. While various scoring systems assign weight based on the presence of ascites, pleural effusion is also important mortality factor in liver transplantation recipients.