Impact of preshunt liver histology on survival following portasystemic shunt surgery for bleeding esophageal varices

Abstract

To determine the value of liver histology in predicting one-year survival after portal venous decompression, eight hepatic histologic features were evaluated prospectively in 53 patients. The presence of panlobular fat and of alcoholic hyaline were the only individual features having a significant correlation with outcome When the predictive power of these histologic features was compared by linear logistic regression analysis to that of 28 clinical and laboratory variables, panlobular fat was the best single predictor, followed in sequence by admission prothrombin time, alcoholic hyaline, admission hematocrit, and Child's C classification. The combination of hematocrit and panlobular fat produced the best two-variable equation, predicting outcome in 79% of patients. No three-variable equation significantly improved upon the two-variable combination of hematocrit and panlobular fat. Therefore certain hepatic histologic features alone or in combination with other factors, appear to be powerful predictors of one-year mortality. When liver biopsy is obtainable, histologic features should be considered in determining suitability for portasystemic shunt surgery.