Following the procedure, 18.9% died within

90 days. In the final multivariable model, the following variables were found to have significant association with 90-day mortality: (1)age (capped at /0; hazard ratio, (HR) = 1.05, 95% confidence interval, Cl = 1.01, 1.10), (2) indication for hydrothorax (HR=3.59, Cl = 1.727.47), and (3) MELDNa (capped at 24, HR=1.22, Cl=1.121.33). For MELDNa, the risk of mortality increase linearly until the score of 24, where the risk did not increase further. The concordance (c) statistic in the model derivation data set was 0.81 (95% CI=0.74-O.87), which was superior to MELDNa alone (cstat=0.76, CI=0.68-0.83), which, in turn, was superior to MELD alone (c-stat=0.69, MK-2206 in vivo Cl=0.60-0.78). In the model validation data

set, the observed and predicted survival matched closely, particularly in low to intermediate risk patients with satisfactory discrimination (c-stat=0.74, CI=0.62-0.86). Conclusions: The updated model, taking into account MELDNa as well as the indication for the procedure, represents an enhanced tool to inform clinicians in their important decision making for application of TIPS. The validation data supports generalized use of the model, especially in identifying patients who have a high likelihood of survival. Disclosures: W. Ray Kim – Advisory Committees or Review Panels: Salix; Consulting: Bristol Myers Sguibb, Gilead Norah Terrault – Advisory Committees or Review Panels: Eisai, medchemexpress Biotest; Consulting: BMS; Grant/Research Support: DNA Damage inhibitor Eisai, Biotest, Vertex, Gilead, AbbVie, Novartis The following people have nothing to disclose: Sang Gyune Kim, Yoon Seon Lee, Patrick S. Kamath, Joseph J. Larson, Terry Themneau, Scott W. Biggins BACKGROUND: Propranolol has a proven effect in primary prevention of variceal bleeding yet the evidence concerning the use of isosorbide-mononitrate (ISMN) in prevention of variceal bleeding is

still controversial. AIM: To assess the efficacy of ISMN as an adjunct to propranolol in primary and secondary prevention of variceal bleeding in children with portal hypertension. METHODS: Sixty nine patients suffering portal hyper-tension of different etiologies were enrolled in this study. Their age ranged between 1-18 years (mean 8.6±3.9 years). They were randomly divided into two groups: group1 (N=29) in whom ISMN (0.5mg/kg) was added to propranolol and group 1(N=40) who continued on propranolol alone. Propranolol was given starting with 0.5mg /kg then the dose was gradually increased till one of the following happened: appearance of any side effects, a 25% drop in heart rate or reaching a maximum dose of 3mg/kg. The patients were followed up for 23.6±5.6 months to observe the incidence of bleeding or rebleeding. Upper GI endoscopy was done for all the children twice; at enrollement into the study and at the end of the follow up period.