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Letter to the Editor: Defining the futility for rTIPS using MELD score and lactate in variceal bleed.

We read with great interest the article by Walter et al. on defining the futility criteria for rescue transjugular intrahepatic portosystemic shunt (rTIPS) in patients with acute variceal bleeding (AVB)1 . Using a combination of model for end stage disease (MELD) score (>25) and serum lactate values (>12 mmol/L), the authors were able to identify a subgroup in whom 6-week mortality following rTIPS was >90%, thus precluding any benefit from it. The combination identified a larger number of patients in whom rTIPS may be futile than that identified by either parameter alone.