To test the relative risk (RR) of primary hepatic carcinoma (PHC) in portal-systemic-shunted patients with cirrhosis of the liver, two autopsy materials were studied, 201 shunted and 378 non-shunted patients with histologically verified cirrhosis. Of these 579 patients, 55 had PHC (cases) and 524 were without PHC (controls). Cases and controls were divided into subgroups in accordance with sex, age, and alcohol consumption habits. Shunted patients with a postoperative survival of more than 6 months were studied separately. For shunted men alive more than 6 months postoperatively, after adjustment for difference in age and presence of large alcohol consumption, a high risk of PHC was found (RR, 3.28; 95% confidence intervals, 1.52-7.45). The presence of HB_sAg was probably without importance for the relative risk of PHC in these patients, since liver tissue HB_sAg was only found in 2 of all 19 shunted patients with PHC.