THE EFFECT OF PROPRANOLOL OS PORTAL PERFUSION IN PATIENTS WITH ALCOHOLIC CIRRHOSIS HAVING DISTAL SPLENORENAL SHUNT

This study tested the hypothesis that reduction in the hyperdynamic sy stemic circulation with propranolol in patients with alcoholic cirrhos is and distal splenorenal shunt would lead to improved maintenance of portal perfusion. After standard distal splenorenal shunt, 50-75% of p atients with alcoholic cirrhosis lose portal flow in 6-12 months: this is associated with an increased hyperdynamic systemic circulation. Tw elve patients with alcoholic cirrhosis with distal splenorenal shunt r eceived propranolol in a dose sufficient to provide beta blockade. Pul se was reduced by 25%, cardiac output reduced by 32% and hepatic venou s pressure gradient reduced by 15% (p<0.05). These significant hemodyn amic changes with propranolol did not lead to any improvement in the m aintenance of portal perfusion: overall, 66% of patients lost prograde portal flow within 1 year. We conclude that the hyperdynamic systemic circulation is not the primary mediator of loss of portal perfusion i n this group of patients. Rather, it appears that differences in eithe r intrahepatic resistance or collateral pathway (portal vein to shunt) resistance must account for the different patterns or maintenance of portal perfusion after distal splenorenal shunt. (C) Journal of Hepato logy.