Peritoneovenous shunt placement was associated with 63% survival at 1 year and 23% at 5 years among patients with refractory ascites secondary to alcoholic liver cirrhosis, according to a retrospective, single-center study published in BMJ Surgery, Interventions & Health Technologies. The study was conducted by Krisztina Fekete and Péter Kupcsulik of Semmelweis University in Budapest, Hungary.
Researchers reviewed 348 consecutive patients who underwent peritoneovenous shunt placement between 1995 and 2015. All patients had refractory ascites due to alcoholic cirrhosis, and none underwent liver transplantation. The cohort included 246 men and 102 women, with a mean age of 55 years. Most patients had advanced disease, with 70% classified as Child-Pugh B and 30% as Child-Pugh C; the mean Model for End-Stage Liver Disease (MELD) score was 15.
Median survival was 25 months, and mean survival was 43 months. Outcomes were worse among patients with more advanced liver disease. In the Results section, 1-year and 5-year survival were 73% and 28% among patients with Child-Pugh B disease compared with 40% and 11% among those with Child-Pugh C disease, although values reported in tables differed slightly. Survival also declined with increasing MELD score, with reported 1-year and 5-year survival of 72% and 38% among patients with scores lower than 9 compared with 33% and 7% among those with scores of 20 to 29.
In multivariate analysis, MELD score remained the strongest independent predictor of survival, whereas Child-Pugh classification was not independently associated with outcomes when analyzed alongside other variables.
Operative mortality within 2 months was 10% overall and was higher among patients with more advanced liver disease, including 21% among those with Child-Pugh C disease and 18% among those with MELD scores of 20 to 29.
In a subgroup of 82 patients treated following 2006 who had contraindications to liver transplantation, 1-year and 5-year survival were 53% and 20%, respectively.
Ascites completely disappeared in 27 cases, about 8% of the cohort, with improvement in liver function. The study noted these patients were abstinent from alcohol following shunt placement, underwent shunt removal, and had no recurrence of ascites.
The study reported shunt occlusion in approximately 128 to 138 patients during follow-up. Among patients who underwent corrective surgery, survival appeared similar to those without occlusion.
The study was limited by its retrospective design, single-center setting, lack of a control group, and changes in treatment practices over the 20-year study period, including the introduction of transjugular intrahepatic portosystemic shunt.
“PVS may be a reasonable option in selected patients, particularly where other options like TIPS or LT are not feasible,” the researchers wrote.
Disclosures: The researchers reported no competing interests.
