title: Preshunt liver function remains the prominent determinant of survival after portasystemic shunting.
abstract: 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.
authors.affiliation: Digestive Disorders Center, Tampa General Hospital and the Department of Surgery, University of South Florida College of Medicine, PO Box 1289, Room F145, Tampa, FL 33601, USA.
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Cowgill
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Carey
authors.forename: Desiree
authors.initials: D
authors.lastname: Villadolid
authors.forename: Sam
authors.initials: S
authors.lastname: Al-Saadi
authors.forename: Emmanuel E
authors.initials: EE
authors.lastname: Zervos
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Rosemurgy
mesh_terms: D000368:Aged; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods; D005260:Female; D006501:Hepatic Encephalopathy / Q000601:surgery; D006505:Hepatitis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D008103:Liver Cirrhosis / Q000401:mortality* / Q000503:physiopathology* / Q000601:surgery; D008104:Liver Cirrhosis, Alcoholic / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D011167:Portacaval Shunt, Surgical / Q000379:methods / Q000401:mortality*; D011446:Prospective Studies; D016019:Survival Analysis; D013997:Time Factors; D014648:Varicose Veins / Q000601:surgery