Hello As per your details and investigations, your father is suffering from 1. HBV related DCLD(MELD - 25), 2. Portal HTN, 3. Refractory Ascites, 4. Hepatic Hydrothorax, 5. Non bleeder/No HE My suggestions would be - To consider evaluation for liver transplant as MELD >14 TIPSS is not a good options in view of AF, but can be considered Optimise diretic therapy Low salt, high protein diet To consider Entecavir in place of Tenofovir as there were two episodes of AKI Antibiotic prophylaxis to prevent SBP/SBE if total protein in ascitic fluid is less than 1 g/dl Therapeutic ascitic tap under albumin cover as and when required