Patient selection and survival after peritoneovenous shunting for nonmalignant ascites

Patient selection and survival after peritoneovenous shunting for nonmalignant ascites was assessed in 30 patients undergoing 44 peritoneovenous shunting procedures over a 5-year period. Indications for peritoneovenous shunting included refractory ascites alone, refractory ascites complicated by hepatorenal syndrome, and nonrefractory but recurrent ascites. Fifty-six percent of shunting procedures were complicated by shunt malfunction and an additional 13% ended in shunt removal or ligation. Serious perioperative morbidity occurred in 47% of patients. Mean duration of shunt function was significantly less (p less than 0.05) in the patients with hepatorenal syndrome (15 +/- 5 days) compared to the patients with refractory ascites alone (45 +/- 13 days), or the patients with nonrefractory ascites (64 +/- 34 days). Mean survival was 265 +/- 87 days. Survival of patients with nonrefractory ascites (767 +/- 214 days) was significantly longer (p less than 0.05) than that seen in patients with hepatorenal syndrome (28 +/- 5 days) or in patients with refractory ascites alone (256 +/- 148 days). Combined inhospital mortality was 30%. It was significantly greater (p less than 0.05) in patients with hepatorenal syndrome (70%) than in patients with refractory ascites alone (14%) or in patients with nonrefractory ascites (0%). We conclude that patient selection significantly influences survival after peritoneovenous shunting and may account for the varying results reported by other groups.