Comparative group study between patients surviving five or more years after portacaval shunt procedure and those...

The classic criteria utilizing preoperative clinical evaluations and laboratory tests for predicting risk and long-term survival in cirrhotic patients under-going portacaval shunting still appear to be the most useful. Analysis of the factors that could be determinant in separating patients who are going to survive a portacaval shunt for five or more years from the short-term survivors revealed the former group had a lesser incidence of preoperative encephalopathy, ascites, malnutrition, and hypoalbuminemia. None of the intraoperative factors were found to be decisive. However, the prompt and uncomplicated postshunt recovery was an accurate prediction for long-term survival. This could be explained by the assumption that these patients had a better hepatic functional reserve at the time of portal-systemic shunting. The early appearance in the postoperative period, of fluid retention, azotemia, oliguria, inability to eat, and the early appearance of the symptoms of portal encephalopathy were premonitory of short-term survival. Return to alcohol ingestion was also associated with short-term survival. The hepatorenal syndrome was usually the cause of death in the short-term survivors whereas nonhepatic disease was the cause of demise in the long-term survivors. The operative mortality for all patients undergoing portacaval shunting during an eight year period was 10.7 per cent. Of the patients who left the hospital alive, 16.1 per cent died within the subsequent twelve months, 53 per cent survived from thirteen to fifty-nine months after their operation, and 19.6 per cent survived sixty or more months.