The effect of propranolol on portal perfusion in patients with alcoholic cirrhosis having distal splenorenal shunt.

This study tested the hypothesis that reduction in the hyperdynamic systemic circulation with propranolol in patients with alcoholic cirrhosis and distal splenorenal shunt would lead to improved maintenance of portal perfusion. After standard distal splenorenal shunt, 50-75% of patients with alcoholic cirrhosis lose portal flow in 6-12 months: this is associated with an increased hyperdynamic systemic circulation. Twelve patients with alcoholic cirrhosis with distal splenorenal shunt received propranolol in a dose sufficient to provide beta blockade. Pulse was reduced by 25%, cardiac output reduced by 32% and hepatic venous pressure gradient reduced by 15% (p < 0.05). These significant hemodynamic changes with propranolol did not lead to any improvement in the maintenance 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 in this group of patients. Rather, it appears that differences in either 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.