Long-term results of peritoneovenous shunt implantation for refractory ascites in patients with alcoholic liver cirrhosis: single-center retrospective study of 348 patients.

Introduction: Despite its reasonable pathophysiological basis, peritoneovenous shunt (PVS) implantation currently plays a very limited role in managing patients with refractory ascites. On the other hand, we have 20 years of experience using PVSs. The aim of this study was to evaluate the clinical efficacy and long-term outcomes of PVS implantation for the treatment of refractory ascites caused by alcoholic liver cirrhosis. Methods: We conducted a retrospective review of 348 consecutive patients who underwent PVS placement. Survival data were compared in subgroups according to: (1) severity of liver cirrhosis; (2) occurrence of shunt occlusion; and (3) patients who had contraindications for liver transplantation (LT). Results: The 1-year and 5-year survival rates for the entire study population were 63% and 23%, respectively. In the shunt occlusion group, the survival rate was comparable with that of the control group: 1-year survival rate was 73%, and 5-year survival rate was 26%. In the strictly selected population where LT was contraindicated, the 1-year and 5-year survival rates were 53% and 20%, respectively. Conclusion: For a well-selected group of patients, PVS implantation is a favorable choice. However, long-term survival data do not justify the highly restricted role of PVS in treatment guidelines.