In our study of a controlled trial of therapeutic portacaval shunt, preliminary data suggest the superiority of surgical over medical treatment. Utilizing the Life-Table method of analysis, our data thus far indicate a 90% to 95% chance that five-year survival for those patients treated by an end-to-side portacaval shunt is 60%, while survival for those treated medically is 10%. As a result of a prospective study, it is concluded that moderate to severe degrees of acute hyaline necrosis adversely influence survival after portacaval shunt in cirrhotic patients. Thus it is recommended that a liver biopsy precede consideration of either an emergency or an elective shunt.