Hepatic pathology as a determinant of prognosis after portal decompression.

The status of 124 patients who had liver biopsies and underwent portal decompression was analyzed and correlated with certain clinical features and hepatic histologic findings. Child risk class, the urgency of operation, the presence of many Mallory bodies, the presence of cirrhosis and the cause of portal hypertension as determined histologically were found to correlate with prognosis. The estimate of hepatic reserve by Child risk class system and the presence of many Mallory bodies were found to have an independent predictive value. The observed differences in prognosis determined by other factors may be accounted for by variations in hepatic reserve. The presence of few or many Mallory bodies appears to be a contraindication to urgent operative portal decompression because of an exceedingly high mortality rate. In addition, the presence of many Mallory bodies regardless of Child class appears to correlate with a poor diagnosis. Since Mallory bodies may occur in all Child risk classes, preoperative liver biopsy is recommended whenever feasible to better define the actual operative risk of any portal decompressive procedure.