Wang Dongping

Liver Transplant Recipients With End-Stage Renal Disease Largely Benefit From Kidney Transplantation

BACKGROUND The incidence of end-stage renal disease (ESRD) after liver transplant (LT) has increased. The actual benefit of kidney transplantation (KT) is not completely understood in LT recipients with ESRD. METHODS We analyzed Scientific Registry of Transplant Recipients data for all KT candidates with prior LT from 1998 to 2014; the benefits of KT relative to remaining on dialysis were compared by means of multivariate Cox proportional hazards regression analysis. RESULTS The number of these KT candidates with prior LT has tripled from 98 in 1998 to 323 in 2015; LT recipients with ESRD remaining on dialysis have a 2.5-times increase in the risk of liver graft failure and a 3.6-times increase in the risk of patient death compared with these patients receiving KT. The adjusted liver graft and patient survival rates after donors from donation after cardiac death or expanded-criteria donor kidney transplantation were significantly higher than in patients remaining on dialysis in LT recipients with ESRD. CONCLUSIONS The number of referrals to KT with prior LT is increasing at a rapid rate. Remaining on dialysis in LT recipients with ESRD has profound increased risks of liver graft failure and patient death in comparison to receiving a KT. LT recipients with ESRD can benefit from expanded-criteria donor and donation after cardiac death kidney transplantation.

e0666 Vasopressin and epinephrine versus epinephrine alone in management of patients with out of hospital cardiac arrest a metaanalysis

Objective A combination of vasopressin and epinephrine may be more effective than epinephrine alone in cardiopulmonary resuscitation, but evidence is lacking to make a clinical recommendation. Our meta-analysis conducted to estimate the efficacy of vasopressin and epinephrine used together versus epinephine alone in out-of-hospital cardiac arrest (CA). Methods We searched MEDLINE for randomised trials comparing the efficacy of vasopressin and epinephrine versus epinephrine alone in adults who experienced out-of-hospital CA. The primary outcome was the return of spontaneous circulation (ROSC) and the survival rate on admission and discharge. We also analysed ROSC in subgroups of patients presenting with different arrest rhythms. Results In total, 206 articles were enrolled and five studies were included. No differences were found between these groups (vasopressin and epinephrine group vs. epinephrine alone group), except for the survival rate at 24 h (OR 2.99, 95% CI 1.43, 6.28). No evidence supports the conclusion that vasopressin combined with epinephrine is better than epinephrine alone for ROSC, even amongst subgroups of patients. Conclusion This systematic review of the efficacy of vasopressin and epinephrine found that its combined use is better for 24 h survival rate but only in one study which included 122 patients. Further investigation will be needed to support the -use of this combination for out-of-hospital CA management.