No Increased Mortality After TIPS Compared with Serial Large Volume Paracenteses in Patients with Higher Model for End-Stage Liver Disease Score and Refractory Ascites

  • James RonaldEmail author
  • Rajiv Rao
  • Steven S. Choi
  • Matthew Kappus
  • Jonathan G. Martin
  • Alan A. Sag
  • Waleska M. Pabon-Ramos
  • Paul V. Suhocki
  • Tony P. Smith
  • Charles Y. Kim
Clinical Investigation TIPS
Part of the following topical collections:
  1. TIPS
  2. TIPS



To compare survival after transjugular intrahepatic portosystemic shunt (TIPS) creation versus serial large volume paracenteses (LVP) in patients with refractory ascites and higher Model for End-Stage Liver Disease (MELD) scores.

Materials and Methods

In this retrospective study, from 1/1/2013 to 10/1/2018, 478 patients (294 male; mean age 58, range 23–89) underwent serial LVP (n = 386) or TIPS (n = 92) for ascites. Propensity-matched cohorts were constructed based on age, MELD, Charlson comorbidity index, varices, and hepatic encephalopathy. Survival was analyzed using a Cox proportional hazards model in which MELD score and TIPS were treated as time-dependent covariates. An interaction term was used to assess the impact of TIPS versus serial LVP on survival as a function of increasing MELD.


In the overall patient sample, higher MELD score predicted worse survival after either serial LVP or TIPS [hazard ratio (HR) = 1.13; p < 0.001], but there was no significant interaction between TIPS and higher MELD score conferring worse survival (HR = 1.01; p = 0.55). In 92 propensity-matched serial LVP and 92 TIPS patients, higher MELD score predicted worse survival after either serial LVP or TIPS (HR = 1.19; p < 0.001), but there was no significant survival interaction between TIPS and higher MELD (HR = 0.97; p = 0.22). In 30 propensity-matched serial LVP patients and 30 TIPS patients with baseline MELD greater than 18, TIPS did not predict worse survival (HR = 0.97; p = 0.94).


Higher MELD predicts poorer survival after either serial LVP or TIPS, but TIPS creation is not associated with worse survival compared to serial LVP in patients with higher MELD scores

Level of Evidence

Level 4, case series.


Transjugular intrahepatic portosystemic shunt Paracentesis Model for End-Stage Liver Disease Survival 


Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required. This article does not contain any studies with animals performed by any of the authors.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2019

Authors and Affiliations

  • James Ronald
    • 1
    Email author
  • Rajiv Rao
    • 1
  • Steven S. Choi
    • 2
  • Matthew Kappus
    • 2
  • Jonathan G. Martin
    • 1
  • Alan A. Sag
    • 1
  • Waleska M. Pabon-Ramos
    • 1
  • Paul V. Suhocki
    • 1
  • Tony P. Smith
    • 1
  • Charles Y. Kim
    • 1
  1. 1.Division of Vascular and Interventional Radiology, Department of RadiologyDuke University Medical CenterDurhamUSA
  2. 2.Division of Gastroenterology, Department of MedicineDuke University Medical CenterDurhamUSA

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