Survival in Cirrhotic Patients with High MELD Scores: The TIPping Point

Excerpt

Although a survival benefit following transjugular intrahepatic portosystemic shunt (TIPS) creation for variceal bleeding [1] and ascites [2, 3] has been reported in randomized controlled trials (RCTs) in cirrhotic patients, clinical outcomes after TIPS placement in patients with late-stage liver disease and high Model for End-Stage Liver Disease (MELD) scores remain controversial. The MELD score was originally created to predict the survival after TIPS placement in patients with cirrhosis; by intention, a high MELD score predicts poor survival after TIPS [4]. While the RCTs supported early TIPS placement for variceal bleeding and favored TIPS over repeated large-volume paracentesis in patients with Child–Pugh scores up to 11 or 13, the investigators intentionally excluded patients with severely compromised liver function and higher scores. The RCTs also did not report on outcomes relative to the MELD scores. …