How do you determine the timing and frequency of therapeutic thoracentesis in patients with symptomatic hepatic hydrothorax?  

It is determined by the patient's symptoms. The patient should also get a paracentesis if there is concomitant ascites, otherwise the pleural effusion will re-accumulate as soon as it is drained unless the ascites is removed.

Main timing is related to symptom frequency, but try not to exceed weekly if possible. If attempting to obtain a transplant exception point, need to be cognizant to document 4 thoracenteses in 6 week period, of which at least 2 have negative cytology after confirming the patient is not a candidate f...