Hepatic iron and zinc concentrations were determined in 26 consecutive nonalcoholic cirrhotic patients who had previously undergone portacaval shunting and then liver transplantation and 37 control patients. Stainable iron was graded on a scale of 0 to 4; 11 shunt patients and 3 control patients had grade 2 to 4 iron staining. Mean hepatic iron concentration was significantly increased (20.1 +/- 4.1 mumol/gm) in the shunt group compared with the control group (9.1 +/- 2.3 mumol/gm) (normal value, < 35 mumol/gm) (p = .015, Student's t test). Mean hepatic iron index (hepatic iron/age) was 0.5 +/- 0.10 in the shunt group and 0.19 +/- 0.04 in the control group (p = 0.002). One shunt patient had a hepatic iron index of greater than 2. Hepatic zinc was not significantly different between the shunt group (2.42 +/- 0.18 mumol/gm) and the control group (2.56 +/- 0.14 mumol/gm). Serial biopsy specimens were analyzed in 17 cases (6 shunt, 11 controls), and the mean annual rate of iron accumulation was significantly greater in shunt patients (4.75 mumol/gm/yr) than in control cases (0.93 mumol/gm/yr, p = 0.037). Although increased stainable iron was common after portacaval shunting, quantitative iron analysis demonstrated increased hepatic iron concentrations in only 6 of 26 shunt patients and 3 of 37 control patients (p = 0.14, chi 2 test). Quantitative hepatic iron analysis demonstrated in this study that portacaval shunt patients have far less accumulated iron than hemochromatosis patients and are unlikely to have tissue injury resulting from iron overload.