Refractory ascites: Midterm results of treatment with a transjugular intrahepatic portosystemic shunt

PURPOSE: To assess midterm results and examine factors associated with successful treatment of refractory ascites with creation of a transjugular intrahepatic portosystemic shunt (TIPS). MATERIALS AND METHODS: In 50 patients with refractory ascites, TIPS creation was performed. Clinical and ultrasound follow-up were performed. Success was defined as survival with no further therapeutic paracentesis and decreased ascites. RESULTS: Mean follow-up was 11.6 months after the TIPS procedure. Major complications occurred in 16% of patients including intraperitoneal hemorrhage, refractory encephalopathy, and progression of liver and renal failure. Overall mortality was 60% (30 patients). In 23 (62%) of 37 patients not lost to follow-up, ascites was controlled successfully at 1-3 months. A bilirubin level greater than 3.0 mg/dL (52 mu mol/L) and creatinine level greater than 1.9 mg/dL (170 mu mol/L) were associated with treatment failure (86% treatment failure at 3 months) and early mortality (P = .03). In all 14 patients alive at 1-year follow-up, ascites was controlled successfully. CONCLUSION: TIPS creation is often useful in treatment of severe ascites not controlled with medical therapy. In patients with advanced liver and renal failure, TIPS creation is not associated with a definite benefit and may hasten death.