Criteria for selection of patients for emergency portacaval shunt

A computer program analysis of the effect on survival of 74 preoperative factors was performed as part of a prospective study of the emergency portacaval shunt in 146 unselected patients with bleeding esophageal varices due to alcoholic cirrhosis. Only ascites, a serum glutamic oxalacetic transaminase level of 100 units or more, and a requirement for 5,000 ml or more of blood transfusion were associated with a statistically significant decrease in survival. However, none of these factors are contraindications to operation because their presence permits a survival rate of 37 to 40 per cent. The only contraindication to emergency portacaval shunt is the combined presence of ascites, jaundice, encephalopathy, and severe muscle wasting, a constellation that was incompatible with survival beyond one year.