Impact of spontaneous splenorenal shunt on liver volume and long-term survival of liver cirrhosis.

Abstract

Spontaneous splenorenal shunt (SSRS) is one of the manifestations of portal hypertension in liver cirrhosis. However, the impact of SSRS on long-term survival of cirrhotic patients remains unclear. We hypothesize that SSRS may worsen liver dysfunction and deteriorate prognosis in liver cirrhosis by decreasing hepatic perfusion. Patients with liver cirrhosis who were admitted to our department between December 2014 and August 2019 and underwent contrast-enhanced computed tomography or magnetic resonance imaging scans were prospectively collected. The maximum diameters of SSRS and portal vein system vessels were retrospectively measured. Liver-to-abdominal area ratio, Child-Pugh, and model for end-stage liver disease scores were calculated. Overall, 122 cirrhotic patients were included. The prevalence of SSRS was 30.3% (37/122). Median diameter of SSRS was 13.5mm. Patients with SSRS had significantly thinner diameters of right portal vein (9mm vs 11.2mm, P=0.001) and main portal vein (15.3mm vs 16.8mm, P=0.017) than those without SSRS. Patients with SSRS had significantly lower liver-to-abdominal area ratio score (25.39 vs 31.58, P<0.001) and higher Child-Pugh (7 vs 6, P=0.046) and model for end-stage liver disease (12.17 vs 9.79, P<0.006) scores than those without SSRS. Patients with SSRS had a significantly lower cumulative survival rate than those without SSRS (P=0.014). Cox regression analysis also showed that SSRS was a risk factor of death of cirrhotic patients (hazard ratio=4.161, 95% confidence interval=1.215-14.255, P=0.023). Spontaneous splenorenal shunt may narrow portal vein diameter and shrink liver volume, thereby worsening liver function and increasing mortality in liver cirrhosis.