Q: A 60-year-old man with cirrhosis presents with refractory ascites requiring frequent large-volume paracentesis. He is evaluated for TIPS placement. Which of the following findings would be the strongest contraindication to proceeding with the procedure?
A) Serum bilirubin of 3.5 mg/dL
B) MELD score of 18
C) Right heart catheterization showing mean pulmonary artery pressure of 55 mmHg
D) History of prior hepatic encephalopathy controlled on lactulose