We acknowledge the challenges identified by the authors in the management of recurrent or refractory ascites.1 Although data identifying candidate suitability for transjugular intrahepatic portosystemic shunt (TIPSS) is satisfactory, the optimum timing of TIPSS remains challenging. This randomized, controlled trial proposes to establish whether such patients might be best managed using large volume paracentesis with supplementary albumin (LVP+A) or TIPSS using a covered stent. Although the reported transplant-free survival rates at the 1-year follow-up seem to be compelling at 52% and 93%, respectively, we feel that aspects of the manuscript raise important questions with regard to patient selection, reasons for the rates of treatment failure, and patient outcomes.