Transjugular intrahepatic portosystemic shunt for ascites: Which patients will benefit?

Transjugular intrahepatic portosystemic shunt (TIPS) is a radiological interventional procedure useful in portal hypertension- related complications. It is able to resolve variceal bleeding and refractory ascites. However, it can lead to serious side effects such as refractory encephalopathy, cardiac failure, and end- stage liver failure. Patients with refractory ascites represent the most frequent indication for TIPS. Clinicians are challenged by the necessity to select the best candidates for TIPS, so that the procedure can be successful as far as both efficacy and survival are concerned. The correct process to select TIPS for cirrhotic patients with ascites includes different steps: first, patients with absolute contraindications, such cardiopulmonary dysfunction or too severe liver failure, should be excluded, and second, criteria to predict post- TIPS survival should be considered. The most effective predictors of survival are serum creatinine, serum bilirubin, serum sodium, age and MELD or Child- Pugh scores. According to an arbitrary choice of two thresholds of different risks for each variable, we propose a simple estimation of the whole risk after TIPS placement.