Survival of alcoholic v nonalcoholic patients after portasystemic shunts

Controversy persists over the comparative survival of alcoholic v nonalcoholic cirrhotic patients who have had portasystemic shunts for therapeutic variceal decompression. We performed a matched retrospective study of 20 alcoholic cirrhotic patients and 20 nonalcoholic cirrhotic patients to determine any difference in survival between these groups and whether this correlated to the results of liver function tests. Patients were matched for age, urgency of operation, number of prior bleeding episodes, and Child's classification. Preoperative levels of albumin, bilirubin, alkaline phosphatase, and prothrombin time were similar in both groups. Operative mortality was 5% in the alcoholic cirrhotic group and 15% in the nonalcoholic group. Average long-term survival was 36 months in the alcoholic group and 43 months in the nonalcoholic group. Preoperative liver function parameters did not correlate with survival. Based on this data, we concluded that the results of preoperative liver tests did not correlate with survival in either group, long-term survival is similar in both groups after portasystemic shunts, and the difference in survival previously reported after a portasystemic shunt may pertain only to high-risk patients.