This is a multicenter, randomized, controlled trial designed to determine if treatment with transjugular intrahepatic portosystemic shunts (TIPS) is superior to high volume paracentesis (total paracentesis) for the treatment of refractory ascites due to cirrhosis. Subjects will be randomized to either receive total paracentesis (TP) alone or TP followed by TIPS within 48 hours. Both groups will be maintained on a sodium restricted diet. Subjects receiving TP alone will be started on diuretics within 36 hours, whereas those receiving TIPS after TP will be started on diuretics if they gain more than 20 pounds. Subjects will be followed for a minimum of one year.