Warm liver ischemia is induced whenever hepatic pedicle clamping performed during liver surgery to minimize operative 
blood loss. The contributory role of intestinal congestion and injury, that follows prolonged hepatic pedicle occlusion, in 
aggravating liver ischemic injury and in inducing remote organ injury is underscored. The hepatic pedicles of twelve dogs were continuously interrupted for 90 minutes. In six dogs portacaval shunts were constructed prior to hepatic pedicle 
occlusion. Two dogs in the control group and all dogs in the shunt group survived for 24 hours after reperfusion (p < 0.05). 
Serum ALT concentrations at 1 and 24 h after reperfusion were significantly higher (p <0.001) in the control versus shunt 
group. Significantly more severe histologic injuries were demonstrated in the liver (grade 4 versus grade 1 respectively, p < 0.005) and the intestine (grade 7 versus grade 1 respectively, p < 0.005) of the control versus the shunt group. The lung and kidney showed morphologic features of acute inflammatory injury in the control but not in the shunt group. We conclude that portacaval shunts, by preventing gut congestion and injury, improve tolerance of the liver to prolonged continuous warm ischemia and prevent its systemic effects on distant organs.