Preshunt liver function remains the prominent determinant of survival after portasystemic shunting

BACKGROUND: Forty-five years after the development of the Child classification, we sought to determine if hepatic function is still a primary determinant between short-term and long-term survival after portasystemic shunting. METHODS: One hundred forty-six patients underwent small-diameter prosthetic H-graft portacaval shunting (HGPCS). The patients were stratified into 2 groups: those surviving less than 5 years and those surviving more than 5 years. Preoperative data determined Child class and model for end-stage liver disease (MELD) score. RESULTS: Ninety-four (64%) patients were short-term and 52 (36%) patients were long-term survivors. No significant differences in the cause of cirrhosis, presence of ascites, encephalopathy, or emergency operations were noted between short- and long-term survivors. Preshunt MELD scores were significantly greater with short-term survivors, although actual survival was superior to predicted survival by MELD. Child class was inferior for short-term survivors. Child class and MELD score significantly correlated with survival after portasystemic shunting. CONCLUSIONS: Long-term survival after HGPCS is possible even with severe hepatic dysfunction; however, actual survival is superior to predicted survival. Hepatic dysfunction, as denoted by Child class and MELD, still remains a primary determinant of survival after portasystemic shunting.