1T he efficacy and safety of pharmacological and behavioral smoking cessation interventions have been examined in multiple randomized controlled trials (RCTs), with subsequent meta-analyses showing that such interventions are efficacious at increasing quit rates.1,2 However, participants in these trials were generally healthy, and the generalizability of these data to patients with cardiovascular disease (CVD) is unclear. This unclear generalizability is underscored by 3 trials that found that the smoking cessation drug bupropion did not increase the prevalence of abstinence when used in patients with acute manifestations of CVD. [3][4][5] This may be because of fundamental differences between such patients, who tend to have higher quit rates without therapy because of an increased motivation to quit and the teachable moment that occurs after an adverse event, 6 and the otherwise healthy smokers enrolled in previous RCTs. 6,7 Similarly, the generalizability of RCTs conducted in the general population to patients with stable CVD is also unknown. A thorough assessment of the effect of smoking cessation interventions in CVD patients is needed to develop tailored recommendations to increase abstinence in the CVD population. Consequently, we conducted a systematic review and network meta-analysis of RCTs to evaluate the relative efficacy and safety of pharmacological and behavioral smoking cessation interventions in CVD patients.Background-Although the efficacy and safety of smoking cessation interventions are well established, their efficacy and safety in patients with cardiovascular disease (CVD) remain unclear. The objective of this study was to evaluate the efficacy and safety of pharmacological and behavioral smoking cessation interventions in CVD patients via a metaanalysis of randomized controlled trials. Methods and Results-EMBASE, PsycINFO, MEDLINE, PubMed, and the Cochrane Tobacco Addiction SpecializedRegister were searched for randomized controlled trials evaluating the efficacy of smoking cessation pharmacotherapies and behavioral therapies in CVD patients. Outcomes of interest were smoking abstinence at 6 and 12 months, defined using the most rigorous criteria reported. Data were pooled across studies for direct comparisons using random-effects models. Network meta-analysis using a graph-theoretical approach was used to generate the indirect comparisons. Seven pharmacotherapy randomized controlled trials (n=2809) and 17 behavioral intervention randomized controlled trials (n=4666) met our inclusion criteria. Our network meta-analysis revealed that varenicline (relative risk [ MethodsOur systematic review and network meta-analysis was performed after a prespecified protocol and is reported using the guidelines described in PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) extension for reporting of systematic reviews incorporating network meta-analyses. 8 Data SourcesWe systematically searched Ovid EMBASE, Ovid PsycINFO, Ovid MEDLINE, PubMed, and the Cochrane Tobacco Addiction G...

Introduction Biliary complications following liver transplantation are common. The effect of intraoperative fluid balance and vasopressors on these complications is unknown. Materials and methods We conducted a cohort study between July 2008 and December 2017. Our exposure variables were the total intraoperative fluid balance and the use of vasopressors on ICU admission. Our primary outcome was any biliary complication (anastomotic and non-anastomotic strictures) up to one year after transplantation. Our secondary outcomes were vascular complications, primary graft non-function and survival. Results We included 562 consecutive liver transplantations. 192 (34%) transplants had a biliary complication, 167 (30%) had an anastomotic stricture and 56 had a non-anastomotic stricture (10%). We did not observe any effect of intraoperative fluid balance or vasopressor on biliary complications (HR = 0.97; 95% CI, 0.93 to 1.02). A higher intraoperative fluid balance was associated with an increased risk of primary graft non-function (non-linear) and a lower survival (HR = 1.40, 95% CI, 1.14 to 1.71) in multivariable analyses. Conclusion Intraoperative fluid balance and vasopressors upon ICU admission were not associated with biliary complications after liver transplantation but may be associated with other adverse events. Intraoperative hemodynamic management must be prospectively studied to further assess their impact on liver recipients’ outcomes.