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Hepatic hydrothorax (HH) is the accumulation of ascitic fluid in the pleural space due to defects in the diaphragm. It is mainly located on the right side. HH occurs in approximately 5%–15% of cirrhotic patients with portal hypertension. Its clinical presentation is non-specific and is mainly revealed by shortness of breath (dyspnea) and a cough. HH infection can occur in the absence of spontaneous bacterial peritonitis and is associated with a high short-term mortality. The poor prognosis of HH is linked to complications of repeated thoracentesis and other invasive procedures to relieve dyspnea. Therapeutic management involves a low-sodium diet and diuretics. Despite this, approximately 20–30% of patients develop refractory HH, and this condition should be considered as a priority for liver transplantation (LT) and/or TIPS placement. Post-LT survival of patients with HH before LT is similar to that of transplanted cirrhotic patients without HH. The severity level of patients with refractory HH is not adequately valued by liver-specific scores (as for refractory ascites). Because of this, a prioritization of patients eligible for LT must be requested from the French Biomedicine Agency (Agence de la Biomedicine).