Preoperative liver biopsy and survival after portasystemic shunting

The value of preoperative liver biopsy in predicting the outcome of portasystemic shunting was investigated. Using coded slides, the authors examined liver biopsy specimens from 41 patients with alcoholic cirrhosis who underwent portasystemic shunting. The degree of fatty change, alcoholic hyalin, alcoholic hepatitis, central hyalin sclerosis and the activity and severity of the cirrhosis were assessed and possible correlations were noted with the preoperative Child's classification, postoperative encephalopathy and with early and late mortality. A correlation was found between the presence of alcoholic hyalin in more than 10% of hepatocytes and early mortality; all of the six patients who died within 30 days of operation had this finding in the liver biopsy specimen. Early mortality correlated better with alcoholic hyalin than with the Child's classification. There was some correlation between late mortality and the degree of hyalin sclerosis and with the activity and severity of cirrhosis. The authors conclude that the findings of a liver biopsy done preoperatively are valuable in indicating prognosis and operative mortality in alcoholic cirrhosis.