RED-CELL SURVIVAL IN PATIENTS WITH NONALCOHOLIC LIVER-CIRRHOSIS BEFORE AND AFTER DISTAL SPLENORENAL SHUNT

We previously reported severe hemolysis in one patient immediately aft er distal splenorenal shunt (DSRS). The purpose of the present study w as to evaluate changes in red cell survival after DSRS, In ten patient s with nonalcoholic cirrhosis in whom DSRS was performed for esophagea l varices, red cell survival and splenic quantitative hemodynamic stud ies were performed before and after DSRS. The splenic venous blood flo w per unit volume (flow/volume ratio) was calculated. The red cell sur vival was significantly (P < 0.05) shortened after DSRS; the apparent half-life survival time (T-1/2) before and after DSRS was 24.6 +/- 5.9 (mean +/- SD) and 16.3 +/- 8.5 days, respectively. After DSRS, the sp leen volume was significantly (P < 0.05) decreased, whereas the spleni c venous blood flow was slightly increased. The spleen flow/volume rat io was significantly (P < 0.05) increased after DSRS. There was a sign ificant and negative correlation (r = -0.684, P < 0.05) between the po stoperative percentage change in T-1/2 and the spleen flow/volume rati o. These findings suggest that the red cell survival period is signifi cantly decreased after DSRS in patients with nonalcoholic cirrhosis. a nd that the increased splenic blood Bow per unit spleen volume after D SRS may play an important role in the hemolytic reaction in the spleen after this procedure.