AbstractBackground Transjugular intrahepatic portosystemic shunt (TIPS) has proven clinical efcacy as rescue therapy for cirrhoticpatients with acute portal hypertensive bleeding who fail endoscopic treatment.Aims To investigate predictive factors of 6-week and 1-year mortality in patients undergoing salvage TIPS for refractoryportal hypertensive bleeding.Methods A total of 144 consecutive patients were retrospectively evaluated. Three logistic regression multivariate modelswere estimated to individualize prognostic factors for 6-week and 12-month mortality. Log-rank test was used to evaluatesurvival according to Child–Pugh classes and Bureau’s criteria.Results Mean age 51±10 years, 66% male, mean MELD 18.5±8.3, Child–Pugh A/B/C 8%/38%/54%. TIPS failure occurredin 23(16%) patients and was associated with pre-TIPS portal pressure gradient and pre-TIPS intensive care unit stay. Six-weekand 12-month mortality was 36% and 42%, respectively. Pre-TIPS intensive care unit stay, MELD, and Child–Pugh scorewere independently associated with mortality at 6 weeks. Independent predictors of mortality at 12 months were pre-TIPSintensive care unit stay and Child–Pugh score.Conclusions In this large cohort of patients undergoing salvage TIPS, MELD and Child–Pugh scores were predictive ofshort- and long-term mortality, respectively. Pre-TIPS intensive care unit stay was independently associated with TIPS failureand mortality at 6 weeks and 12 months. Salvage TIPS is futile in patients with Child–Pugh score of 14–15.