Short-term patient and graft outcomes continue to improve after kidney and liver transplantation, with 1-year survival rates over 80%; however, improving longer-term outcomes remains a challenge. Improving the function of grafts and health of recipients would not only enhance quality and length of life, but would also reduce the need for retransplantation, and thus increase the number of organs available for transplant. The clinical transplant community needs to identify and manage those patient modifiable factors, to decrease the risk of graft failure, and improve longer-term outcomes.COMMIT was formed in 2015 and is composed of 20 leading kidney and liver transplant specialists from 9 countries across Europe. The group's remit is to provide expert guidance for the long-term management of kidney and liver transplant patients, with the aim of improving outcomes by minimizing modifiable risks associated with poor graft and patient survival posttransplant.The objective of this supplement is to provide specific, practical recommendations, through the discussion of current evidence and best practice, for the management of modifiable risks in those kidney and liver transplant patients who have survived the first postoperative year. In addition, the provision of a checklist increases the clinical utility and accessibility of these recommendations, by offering a systematic and efficient way to implement screening and monitoring of modifiable risks in the clinical setting.

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Practical Recommendations for Long-term Management of Modifiable Risks in Kidney and Liver Transplant Recipients: A Guidance Report and Clinical Checklist by the Consensus on Managing Modifiable Risk in Transplantation (COMMIT) Group.

Effective immunosupression management is central to achieving optimal outcomes in liver transplant recipients. Current immunosuppression regimens and agents are highly effective in minimizing graft loss due to acute and chronic rejection but can also produce a substantial array of toxicities. The utilization of immunosuppression varies widely, contributing to the wide disparities in posttransplant outcomes reported between transplant centers. The International Liver Transplantation Society (ILTS) convened a consensus conference, comprised of a global panel of expert hepatologists, transplant surgeons, nephrologists, and pharmacologists to review the literature and experience pertaining to immunosuppression management to develop guidelines on key aspects of immunosuppression. The consensus findings and recommendations of the ILTS Consensus guidelines on immunosuppression in liver transplant recipients are presented in this article.

International Liver Transplantation Society Consensus Statement on Immunosuppression in Liver Transplant Recipients.

These guidelines cover the care of patients from the period following kidney transplantation until the transplant is no longer working or the patient dies During the early phase prevention of acute rejection and infection are the priority After around 3–6 months, the priorities change to preservation of transplant function and avoiding the long-term complications of immunosuppressive medication (the medication used to suppress the immune system to prevent rejection) The topics discussed include organization of outpatient follow up, immunosuppressive medication, treatment of acute and chronic rejection, and prevention of complications The potential complications discussed include heart disease, infection, cancer, bone disease and blood disorders There is also a section on contraception and reproductive issues Immediately after the introduction there is a statement of all the recommendations These recommendations are written in a language that we think should be understandable by many patients, relatives, carers and other interested people Consequently we have not reworded or restated them in this lay summary They are graded 1 or 2 depending on the strength of the recommendation by the authors, and AD depending on the quality of the evidence that the recommendation is based on

/pdf/renal-association-clinical-practice-guideline-in-post-59t11wf9bd.pdf

Renal association clinical practice guideline in post-operative care in the kidney transplant recipient.

The mTOR pathway has a role in the development of renal disease, kidney transplant rejection and malignancies. Here, the authors discuss the mechanisms by which mTOR complexes drive the pathogenesis of these diseases as well as the therapeutic potential of mTOR inhibitors.

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Roles of mTOR complexes in the kidney: implications for renal disease and transplantation.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/ajt.14382

Skin Cancers in Organ Transplant Recipients

We propose a new sleep quality measure that assesses the sleep restorative gain of a polysomnography sleep record. In this preliminary investigation, we derive this new measure from manually scored sleep hypnograms. We compare the proposed measure to classical sleep indices such as TST, SE, and ArI, and demonstrate its self-consistency and degree of correlation with these measures. Using 47 sleep records from publicly available sleep databases, we graphically and quantitatively demonstrate the effectiveness of the proposed measure in summarizing the hypnogram of a sleep record.

Consistency of Sleep Restoration Gain (SRG) as a measure for assessing sleep quality

This prospective study reports the design and results obtained after the EMPODaT project implementation. This project was funded by the Tempus programme of the European Commission with the objective to implement a common postgraduate programme on organ donation and transplantation (ODT) in six selected universities from Middle East/North Africa (MENA) countries (Egypt, Lebanon and Morocco). The consortium, coordinated by the University of Barcelona, included universities from Spain, Germany, Sweden and France. The first phase of the project was to perform an analysis of the current situation in the beneficiary countries, including existing training programmes on ODT, Internet connection, digital facilities and competences, training needs, and ODT activity and accreditation requirements. A total of 90 healthcare postgraduate students participated in the 1-year training programme (30 ECTS academic credits). The methodology was based on e-learning modules and face-to-face courses in English and French. Training activities were evaluated through pre- and post-tests, self-assessment activities and evaluation charts. Quality was assessed through questionnaires and semi-structured interviews. The project results on a reproducible and innovative international postgraduate programme, improvement of knowledge, satisfaction of the participants and confirms the need on professionalizing the activity as the cornerstone to ensure organ transplantation self-sufficiency in MENA countries.

Design and implementation of the European-Mediterranean Postgraduate Programme on Organ Donation and Transplantation (EMPODaT) for Middle East/North Africa countries.

We present a new adaptive system for automated sleep staging. The proposed system relies on each subject's own data for self-training. Conventional automatic sleep staging algorithms are either rule based, which typically fail to accurately model the complex nature of sleep signals, or numerical methods that use multi-patient training schemes, which suffer from inaccuracies caused by inherent inter-patient variability. The proposed system employs two stages. The first stage is a rule based reasoning engine that can be tuned conservatively to decrease or eliminate false positives, generating just enough samples to train the second stage, which is comprised of a neural network classifier. Results show that this hybrid approach provides an adaptive training scheme that performs more accurately compared to one of the popular commercially available systems.

Adaptive hybrid system for automatic sleep staging

Mp85-14 Is There A Role For Preconditioning The Kidney Before Warm Ischemia With Sildenafil?

Obesity is one of the leading cause of a set of chronic diseases. Successful weight-loss interventions depend on changing the unhealthy lifestyle and maintaining awareness of individual's eating habits. Recent nutritional behavior management systems are considered as open loop systems. In this study, we propose a closed loop strategy through monitoring and evaluation of various food intake activities. Wireless surface electromyogram (sEMG) was deployed in order to differentiate between meal, snack and drink activities through a multistage classification system. The proposed algorithm was able to discriminate between eating and drinking activities with accuracy of 96% using time domain features and K-Nearest Neighbour classifier (KNN). Furthermore using Hilbert transform based classifier, we scored 97.5% accuracy for drinking/saliva swallowing classification and 93% accuracy for swallowing/chewing activities classification. These results suggest high efficiency of the proposed methodology in identifying the ingestive behaviour.

Ahmed Morsy

Papers

Consistency of Sleep Restoration Gain (SRG) as a measure for assessing sleep quality

Design and implementation of the European-Mediterranean Postgraduate Programme on Organ Donation and Transplantation (EMPODaT) for Middle East/North Africa countries.

Adaptive hybrid system for automatic sleep staging

Mp85-14 Is There A Role For Preconditioning The Kidney Before Warm Ischemia With Sildenafil?

Monitoring and evaluation of ingestive activities