The objective of this study was to assess the prognostic value of spontaneous portosystemic shunting and liver function for survival and spontaneous
hepatic encephalopathy after end-to-side
portacaval shunt in cirrhotic patients. One hundred ninety-eight patients with variceal
hemorrhage as shown by endoscopy were evaluated. Forty-five were excluded because of uncontrollable
hemorrhage; 84 were rejected because they were poor operative risk, had portal vein
thrombosis or had been previously treated with beta-blockers,
sclerotherapy or surgery. The remaining 69 patients were enrolled in this prospective study. There were 43 patients with
alcoholic cirrhosis, 23 with
cryptogenic cirrhosis and three with
primary biliary cirrhosis. The severity of
liver disease was assessed according to the Pugh classification: 37 patients (54%) had Pugh's score 5 to 7, 26 (38%) had 8 to 10 and six (8%) had 11 to 12.
Indocyanine green intrinsic clearance was used as a probe of preoperative liver function and
lidocaine systemic availability as an index of spontaneous preoperative shunting. All the patients underwent an elective end-to-side
portacaval shunt. The length of minimal follow-up was 40 months. One-year survival was 76% and 5-year survival was 46%. During follow-up, 25 patients died from their
liver disease and 11 patients died from various causes unrelated to their
liver disease. Spontaneous
chronic encephalopathy occurred in 16 patients (23%). Age, Pugh's score, active
alcoholism,
indocyanine green intrinsic clearance and
lidocaine systemic availability were tested as prognostic factors in a multivariate analysis.(ABSTRACT TRUNCATED AT 250 WORDS)