OBJECTIVE: This study suggests that patients with medically refractory ascites treated with transjugular intrahepatic portosystemic shunt (TIPS) may have improved in overall clinical status. METHODS: We performed a retrospective study of 35 patients with medically refractory ascites treated with TIPS. Body weight, ascites, and Child-Pugh score were assessed at baseline, at 2 months, and after a mean 8.8-month follow-up interval. RESULTS: After TIPS, there was significant improvement in Child-Pugh score from 9.7+/-1.5 to 8.2+/-2.3. Ascites completely resolved or improved in 23 of 24 patients (96%) who had long term follow-up. Two months after TIPS, there was a significant decrease in weight of 6.1 kg corresponding to a loss of ascites. Between 2 and 8.8 months, there was a significant mean weight gain of 5.5 kg. CONCLUSION: This study suggests that patients treated with medically refractory ascites with TIPS may have improvement in overall clinical status, as measured by increase in lean body mass and improvement in Child-Pugh score.