Conventional predictors of survival poorly predict and significantly underpredict survival after H-graft portacaval shunts.
OBJECTIVE
This study was undertaken to evaluate the ability to predict survival after 8 mm prosthetic H-graft portacaval shunts (HGPCS).


METHODS
Since 1988, 170 patients have been prospectively followed after HGPCS. Using preshunt data, predictors of survival after shunting [MELD Score, Emory Score, Child Pugh Score, Discriminant Function (DF), and Child Class] were determined and related to actual survival.


RESULTS
Child Class was: (a) 10%, (b) 28%, and (c) 62%. Actual 5- and 10-year survival by Child Class was: (a) 67% and 33%, (b) 49% and 16%, (c) 29% and 7%. Survival correlated with all predictors of survival (p < 0.01 for each). Actual survival was better than predicted by MELD (p < 0.001). By Multiple Variable Regression Analysis--Computed Model, explained variation in survival was greatest for Child Class (18%), followed by MELD (14%), with DF, Emory Score, and Child Pugh Score not significantly contributing.


CONCLUSIONS
After HGPCS, actual survival is better than predicted by MELD. Child Class explains only a minor variation in survival, although it better explains survival than MELD, Emory Score, Child Pugh Score, or DF. Conventional predictors of survival poorly and underpredict survival after HGPCS and should be used with caution.
Cowgill
Sarah M
SM
Division of General Surgery, University of South Florida, Tampa General Hospital, P.O. Box 1289, Rm F145, Tampa, FL, 33601, USA, arosemur@hsc.usf.edu.
Thometz
Donald
D
Clark
Whalen
W
Villadolid
Desiree
D
Carey
Elizabeth
E
Pinkas
Daphne
D
Zervos
Emmanuel
E
Rosemurgy
Alexander
A
D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011167:Portacaval Shunt, Surgical / Q000379:methods*; D011183:Postoperative Complications; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D016019:Survival Analysis