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.

/pdf/practical-recommendations-for-long-term-management-of-41r0cgop8b.pdf

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.

/pdf/roles-of-mtor-complexes-in-the-kidney-implications-for-renal-1v1kg9is45.pdf

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

/pdf/numerical-analysis-for-smoke-spread-in-an-aircraft-hangar-500mh7mu20.pdf

Numerical Analysis For Smoke Spread In An Aircraft Hangar

Biomedical computing in the Arab world: unlocking the potential of a growing research community

Short Segment with Index Vertebra Fixation versus Long Segment Fixation in the Management of Thoracolumbar Fractures

Background: Placement of a percutaneuos nephrostomy tube for drainage has been an integral part of the standard Percutaneous Nephrolithotomy (PNL) procedure. However, in recent years, the procedure has been modified to what has been called tubeless PNL, in which the nephrostomy tube is replaced with internal drainage by ureteral catheter or doubleJ stent. Aim of Study: This study aims to assess the safety, efficacy and complications of tubeless minimally invasive percutaneous nephrolithotomy (mini PNL) in lower calyceal stones. Patients and Methods: Patients with lower calyceal stones ≤2cm were enrolled and underwent tubeless mini PNL between February 2014 and January 2016 using a semi rigid ureteroscope through a 16 Fr sheath and holmium laser lithotripsy. Patients were considered stone free when no stones or residuals <3mm were found on plain X-ray UT or non contrast CT. Result : Twenty four patients with mean age of 39.8 ±7.1 years underwent mini PNL for lower calyceal stones ranging in size from 10-20mm (15.47±3.04). A single tract was used (16Fr). All patients had a tubeless procedure. Mean hospital stay was 1.5±0.1 days. Twenty patients (83.4%) had no or mild post-operative pain that required no analgesia. Minor complications occurred in two patients (8.3%) in the form of post-operative fever that was treated conservatively. Conclusion: Tubeless PNL can be safe and effective procedure in selected patients (stone burden <2cm, single tract access, no significant residual stones, no significant perforation, minimal bleeding, and no requirement for a secondary procedure), with the potential advantages of decreased post-operative pain, analgesia requirement, and hospital stay. Stone Free Rate (SFR) is comparable to PNL and is significantly better than SWL and RIRS.

https://mjcu.journals.ekb.eg/article_64911_f399a91b20a1ad61beac945f0133c997.pdf

Ahmed Morsy

Papers

Numerical Analysis For Smoke Spread In An Aircraft Hangar

Biomedical computing in the Arab world: unlocking the potential of a growing research community

Short Segment with Index Vertebra Fixation versus Long Segment Fixation in the Management of Thoracolumbar Fractures

Effectiveness and Safety of Tubeless Minimally Invasive Percutaneous Nephrolithotomy in Management of Lower Pole Renal Stones