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While its effect on short\u2010term survival is well\u2010documented, its long\u2010term implications remain unclear.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>This study aims to investigate the long\u2010term impact of post\u2010TIPS OHE on mortality in cirrhotic patients for variceal bleeding, focusing on the timing and predictive value of OHE beyond the first year post\u2010TIPS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A multicenter, retrospective cohort study was conducted involving 3262 cirrhotic patients who underwent TIPS for variceal bleeding at seven Chinese tertiary centers between January 2010 and June 2020. Clinical data, including demographics, procedure details, post\u2010TIPS complications and survival outcomes, were collected. The primary endpoints were all\u2010cause mortality and OHE, with follow\u2010up until death, liver transplantation or 60\u2009months. Propensity score matching minimised confounding effects, and multivariate Fine\u2010Grey competing risk models identified independent mortality predictors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>During a median follow\u2010up of 1077\u2009days, 33.2% developed post\u2010TIPS OHE, associated with higher MELD and Child\u2010Pugh scores. Among these, 19.3% died, with a median time from OHE onset to death of 947\u2009days. Post\u2010TIPS OHE was not linked to early survival (within 12\u2009months) but emerged as an independent predictor of long\u2010term mortality beyond 24\u2009months, consistent across various clinical scenarios.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Post\u2010TIPS OHE does not affect short\u2010term survival but significantly increases long\u2010term mortality risk. These findings highlight the need for continuous monitoring and tailored interventions to improve long\u2010term outcomes in post\u2010TIPS patients.<\/jats:p><\/jats:sec>","DOI":"10.1111\/apt.18509","type":"journal-article","created":{"date-parts":[[2025,2,18]],"date-time":"2025-02-18T00:53:06Z","timestamp":1739839986000},"page":"1183-1196","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Post\u2010<scp>TIPS<\/scp> Overt Hepatic Encephalopathy Increases Long\u2010Term but Not Short\u2010Term Mortality in Cirrhotic Patients With Variceal Bleeding: A Large\u2010Scale, Multicenter Real\u2010World Study"],"prefix":"10.1111","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8969-7371","authenticated-orcid":false,"given":"Yi","family":"Xiang","sequence":"first","affiliation":[{"name":"Liver Disease Center of Integrated Traditional Chinese and Western Medicine, Department of Radiology, Zhongda Hospital, 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