Effect of distal splenorenal shunt on survival of patients with primary biliary cirrhosis

Authors

  • Thomas D. Boyer M.D.,

    Corresponding author
    1. Departments of Medicine, Atlanta, Georgia 30322
    • Thomas D. Boyer, M.D., Division of Digestive Diseases, P.O. Drawer AL, Emory University School of Medicine, Atlanta, GA 30322
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  • Dennis D. Kokenes,

    1. Departments of Medicine, Atlanta, Georgia 30322
    Current affiliation:
    1. Dennis D. Kokenes, M.D., 2015 Randolph Rd., Suite 208, Charlotte, NC 28207
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  • Gary Hertzler,

    1. Departments of Pathology, Atlanta, Georgia 30322
    Current affiliation:
    1. Department of General Surgery (A11), The Cleveland Clinic Foundation, One Clinic Center, 9500 Euclid Avenue, Cleveland, OH 44195
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  • Michael H. Kutner,

    1. Division of Biostatistics, Emory University School of Public Health, Atlanta, Georgia 30322
    Current affiliation:
    1. Department of Biostatistics and Epidemiology, The Cleveland Clinic Foundation, One Clinic Center, 9500 Euclid Avenue, Cleveland, OH 44195
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  • J. Michael Henderson

    1. Surgery, Emory University School of Medicine, Atlanta, Georgia 30322
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Abstract

Distal splenorenal shunt is known to effectively control bleeding from esophageal and gastric varices; however, the effect of this selective shunt on liver function is less well understood. We examined retrospectively the effect of distal splenorenal shunt on the survival of 19 patients with primary biliary cirrhosis subjected to surgery for bleeding varices over a 20-yr period and had been followed for at least 1 yr. Actual Kaplan-Meier survival curve was compared with predicted survival curve based on the Mayo Clinic model using clinical data collected at the time of surgery. The patients median length of follow-up was 65.9 mo. Ten of the 19 patients died or underwent orthotopic liver transplantation during the period of observation. The actual Kaplan-Meier and predicted Mayo Clinic model survival curves were similar and did not differ significantly. Survival was best in patients with good liver function (i.e., low Mayo risk scores). Distal splenorenal shunt, therefore, did not appear to have an adverse effect on the survival of patients with primary biliary cirrhosis. We conclude that variceal bleeding in primary biliary cirrhosis patients with good liver function should not be considered an indication for liver transplantation. Instead, if treatment with sclerotherapy or β-blockers fails then distal splenorenal shunt will prevent recurrent bleeding in 90% of patients and leave them with an excellent prognosis. (Hepatology 1994;20:1482–1486).

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