Data on 100 consecutive patients undergoing portasystemic shunt at three hospitals of the University of California, San Francisco, were analyzed retrospectively to look for variables portending poor immediate and long-term outcome. As a determinant of early mortality after portacaval shunt, the Child's classification of the patient remains the single most important factor. If the patient is in Child's class C and has a hematocrit of less than 32 percent, he is even less likely to survive 30 days. The malnourished male patient who resumes drinking postoperatively is least likely to survive 1 year. Though short- and long-term mortality did not correlate with type of shunt, the prosthetic interposition mesocaval shunt was associated with an unacceptably high thrombosis rate of 20 percent in our institutions, and represented a technical failure to achieve the goal of preventing further variceal bleeding. No matter what type of shunt was performed, however, the 30 day mortality of Child's class C patients exceeded 50 percent. In the latter patients methods of treatment other than portasystemic shunts should be evaluated.
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