Research tagged [hepatology]

Transjugular Intrahepatic Portosystemic Shunt (TIPS) versus Serial Large-Volume Paracentesis for Refractory Ascites in Cirrhosis with MELD 18: A Clinical Decision Analysis and Evidence Synthesis

Patients with advanced cirrhosis frequently develop refractory ascites, a significant cause of morbidity and mortality. Management options include serial large-volume paracentesis (LVP) and transjugular intrahepatic portosystemic shunt (TIPS). This paper synthesizes expert clinical perspectives and current literature to address the optimal management strategy for a 56-year-old male with alcohol-related cirrhosis, Child-Pugh C, and a MELD score of 18, experiencing refractory ascites requiring frequent LVP. The discussion focuses on the efficacy, safety, and transplant implications of TIPS compared to LVP. Evidence from meta-analyses and real-world cohorts suggests TIPS offers superior ascites control and potential transplant-free survival benefits, particularly in carefully selected patients. While a MELD score of 18 approaches a critical threshold for increased post-TIPS mortality, factors such as sustained abstinence, absence of current hepatic encephalopathy, and technical feasibility favor TIPS in this specific case. The interaction of TIPS with liver transplant candidacy and surgical complexity is also explored, indicating minimal adverse impact. This analysis underscores the importance of individualized risk-benefit assessment in managing refractory ascites at the MELD 18 threshold, advocating for TIPS with a tailored protocol to mitigate risks and improve patient outcomes while awaiting liver transplantation.