title: 507 Warren-Zeppa distal splenorenal shunts: a 34-year experience.
abstract: OBJECTIVE
  To define the long-term characteristics, prognostic factors, and outcomes of patients undergoing selective splenorenal shunting procedures for portal hypertension-induced recurrent upper gastrointestinal bleeding.
  
  
  METHODS
  A retrospective evaluation of a prospectively collected data set.
  
  
  RESULTS
  From June 1971 through May 2005, 507 Warren-Zeppa shunts were performed at a single institution. Indications included: alcoholic cirrhosis, 52.6%; viral cirrhosis, 21.8%; cryptogenic cirrhosis, 8.4%; autoimmune cirrhosis, 5.8%; and other causes, 6.3%. Median survival was 81 months (5-year survival, 58.9%; 10-year survival, 34.4%; 20-year survival, 12.5%). patients with portal vein thrombosis and biliary cirrhosis demonstrated better survival than others (P = 0.03), while patients with alcoholic cirrhosis trended toward worse survival than those with nonalcoholic causes (P = 0.11). Multivariate analysis of preoperative risk factors found body hair loss (hazard ratio, 17.3; P > 0.005), preoperative encephalopathy (hazard ratio, 1.93; P > 0.003), diuretic use (hazard ratio, 1.43; P > 0.003), and age (hazard ratio, 1.02 per year of age; P > 0.051) were independent predictors of poor long-term survival. Multivariate analysis of operative factors demonstrated blood loss <500 mL was predictive of up to a 4-fold improved long-term survival (hazard ratio, 3.95; P < 0.013). Postoperative complications included: recurrent bleeding, 12%; ascites, 17.5%; and encephalopathy, 13.9%. Multivariate analysis of postoperative factors prospectively collected in 130 patients found that alcoholic recidivism (hazard ratio, 2.66; P > 0.001) was the only independent predictor of poor prognosis.
  
  
  CONCLUSIONS
  The Warren-Zeppa shunt provides long-term survival and control of bleeding in most patients with portal hypertension. Excellent long-term survival can be obtained in properly selected patients with portal hypertension and relatively spared hepatic function.
authors.affiliation: Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA. alivings@med.miami.edu
authors.forename: Alan S
authors.initials: AS
authors.lastname: Livingstone
authors.forename: Leonidas G
authors.initials: LG
authors.lastname: Koniaris
authors.forename: Eduardo A
authors.initials: EA
authors.lastname: Perez
authors.forename: Nicholas
authors.initials: N
authors.lastname: Alvarez
authors.forename: Joe U
authors.initials: JU
authors.lastname: Levi
authors.forename: Duane G
authors.initials: DG
authors.lastname: Hutson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications*; D007223:Infant; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013164:Splenorenal Shunt, Surgical / Q000706:statistics & numerical data*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome