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Kidney transplant from a monozygotic twin living donor with no maintenance immunosuppression
Trasplante renal de donante vivo entre gemelos monocigotos sin inmunosupresión de mantenimiento
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"nombre" => "Fritz" "apellidos" => "Diekmann" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Sección de Nefrología, Hospital Clínic Barcelona, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Sección de Nefrología, Hospital de Guadalajara, Guadalajara, Mexico" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Trasplante renal de donante vivo entre gemelos monocigotos sin inmunosupresión de mantenimiento" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Renal transplant from a living monozygotic twin donor, though uncommon, may be considered the ideal renal transplant procedure, given the good renal and overall survival rates it offers. It also offers the opportunity to minimise or stop immunosuppressive therapy.</p><p id="par0010" class="elsevierStylePara elsevierViewall">In 1954, Murray et al. carried out the first successful renal transplant between monozygotic twins without immunosuppressive therapy.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">1</span></a> Following the success of that transplant, in the 1950s and 1960s, various case series were described throughout the world with good renal survival.<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">2–5</span></a> Subsequently, with the advent of modern immunosuppression in the 1970s, in order to avoid acute rejection and primary disease recurrence, patients with a transplant from a monozygotic twin donor started to receive maintenance immunosuppressive therapy, despite the supposed absence of alloimmune response due to being monozygotic twins.<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">6,7</span></a> Currently, there are no randomised studies or clinical guidelines that evaluate what type or dose of immunosuppression should be given in renal transplants from monozygotic twins. There are reviews recommending the use of single-dose methylprednisolone and the use of other immunosuppressors for a short period.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">8</span></a> There are also case series of renal transplants between monozygotic twins that minimised, or did not give, immunosuppressive therapy, with good renal outcome.<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">9–12</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">To assess the need to administer or to stop maintenance immunosuppressive therapy, it has been proposed that patients undergoing this type of transplant have zygosity analysis using DNA analysis to establish the differences between monozygotic twins (those that share 100% of their genetic material) and dizygotic twins (those that share approximately 50% of their genetic material).<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">13</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The aim of this study was to evaluate the clinical response of recipients of renal transplants from living monozygotic twin donors, in transplants performed at our centre without maintenance immunosuppressive therapy.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">This was an observational retrospective study of living donor renal transplants between monozygotic twins performed in the Nephrology Department of <span class="elsevierStyleItalic">Hospital Clínic de Barcelona</span>, between 1969 (the first renal transplant performed in the hospital) and 2013.</p><p id="par0030" class="elsevierStylePara elsevierViewall">We identified 5 patients who had a renal transplant from a living monozygotic twin donor. Clinical and analytical data were collected at one year post-transplant and at most recent follow-up. Monozygosity was not analysed with DNA techniques, zygosity being assumed from HLA typing.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The 5 patients received a single dose of 500<span class="elsevierStyleHsp" style=""></span>mg of methylprednisolone in the operating theatre as immunosuppressive therapy. No other immunosuppressive treatment was started. The patients did not receive prophylaxis against cytomegalovirus.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Results</span><p id="par0040" class="elsevierStylePara elsevierViewall">The mean age of the 5 recipients of renal transplant from an identical twin was 27 years (range 20–39 years) at the time of transplant. All patients shared blood group and 6 HLA identities with their donors. One patient had previously received a transplant. The cause of end stage renal disease was not identified in 3 patients. One patient had membranoproliferative glomerulonephritis and one patient (previously transplanted) had interstitial nephropathy.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Patient survival and graft survival at 1 year were 100%. Mean creatinine at 1 year was 0.96<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.2<span class="elsevierStyleHsp" style=""></span>mg/dL. At 5 years, both patient survival and renal survival were 100%. Mean creatinine was 1.2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.37<span class="elsevierStyleHsp" style=""></span>mg/dL. One patient died with a functional graft (last creatinine 0.8<span class="elsevierStyleHsp" style=""></span>mg/dL) 16 years after the transplant, due to malignant melanoma with multi-organ metastases, aged 41 years. Another patient died aged 65 years due to a cardiovascular event, 22.5 years after transplant (last creatinine 1.5<span class="elsevierStyleHsp" style=""></span>mg/dL). One patient was lost to follow-up at 1 year with a functioning graft and creatinine of 1.2<span class="elsevierStyleHsp" style=""></span>mg/dL. The 2 remaining patients were still alive at 18 months and 42.5 years post-transplant, with functioning kidneys and serum creatinine of 1.2<span class="elsevierStyleHsp" style=""></span>mg/dL and 1.1<span class="elsevierStyleHsp" style=""></span>mg/dL, respectively (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). The last transplant patient had protocol biopsies at 3 months and 1 year, with no signs of cellular or humoral rejection. The other patients did not have a biopsy because they had normal renal function and protocol biopsies were not done at that time. None of the 5 patients has had clinical acute rejection and they have not received any further immunosuppressive therapy during their follow-up.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Discussion</span><p id="par0050" class="elsevierStylePara elsevierViewall">Our series of 5 cases of renal transplant between monozygotic twins treated with intra-operative single-dose methylprednisolone with no maintenance immunosuppression shows good renal and overall survival without risk of developing acute rejection or chronic humoral rejection.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Living donor transplantation represents a way to increase preventative renal transplants and transplants for patients on the waiting list, as it offers better renal survival and quality of life, and is a cost-effective treatment.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">14</span></a> Currently, living donor renal transplant makes up around 50% of all renal transplants in some countries, and this percentage is increasing in countries such as Spain, which previously were performing mainly cadaveric donor transplants.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">15</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Various studies have shown that donation between monozygotic twins is the best treatment option with excellent renal and overall survival, but there is disagreement regarding the immunosuppressive therapy they should receive.<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">6,12</span></a> Kessaris et al. showed that in the United Kingdom more than 50%, and in the USA more than 2 thirds of patients with a renal transplant from their identical twin were receiving long-term immunosuppressive therapy.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">6</span></a> The authors explained that in some patients, immunosuppression was given to prevent primary disease recurrence, despite the majority of patients not having a primary renal disease at risk of recurrence. In the survival analysis, patients with a theoretically elevated risk of recurrence who did not receive immunosuppressive therapy, had no increased risk of primary disease recurrence. In the review by Krishnan et al. of the Organ Procurement Transplant Network database from 1987 to 2006, it was shown that 71% of patients with a transplant from an identical twin stopped immunosuppressive therapy at 1 year, 33% continued with some type of immunosuppression, and 13% continued with standard triple therapy. In the survival analysis the group that stopped immunosuppression had better renal survival at 1 year.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">12</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Given the results obtained by other groups and our results, it seems reasonable to propose reducing immunosuppression to the absolute minimum in living donor renal transplants between identical twins. In the ideal situation of monozygotic twins, we propose giving an intra-operative single dose of steroids with the aim of preventing ischaemia–reperfusion damage. Damage from ischaemia–reperfusion during surgery activates various cytokines that can activate the immune response despite complete HLA identity between the donor and recipient. It has also been described that ischaemia can modify donor DNA and genetic expression post-transplant.<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">16</span></a> Therefore, we suggest the use of intra-operative steroids to block the immune response at several levels and reduce the risk of acute rejection. The potential benefits of subsequent immunosuppressive therapy should be carefully evaluated in patients with risk of primary disease recurrence, because immunosuppressive therapy, particularly with steroids and calcineurin inhibitors, is associated with serious infectious, cardiovascular, and oncological complications, as well as the deleterious effect of calcineurin inhibitors on the graft.<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">17,18</span></a> In our series, we emphasise that we have observed no acute or chronic rejection as a long-term cause of graft loss with the proposed immunosuppression model, but there was 1 case of neoplasia, despite not being on immunosuppressive therapy. We think that this neoplasm, 16 years post-transplant, was unrelated to the transplant, as the incidence of this type of tumour is one of the most increasing in Spain.<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">19</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">DNA analysis has been used, historically, to determine monozygosity.<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">20,21</span></a> Nowadays, monozygosity tests using DNA analysis are available and can be used to assess the need for immunosuppressive therapy and prevent graft rejection, or when there is a high risk of primary disease recurrence. Krishnan et al. recommended pretransplant monozygosity analysis using DNA in saliva.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">12</span></a> A recent review proposed always performing zygosity studies in twins, since 25% of dizygotic twins can have complete HLA identity and so would falsely be presumed monozygotic.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">22</span></a> The authors proposed multilocus testing (analysing various loci from different chromosomes) to identify a series of DNA fragments that are present in all individuals, but which are highly variable, and which would allow identification of monozygotic twins. This technique is known as multilocus DNA fingerprinting.</p><p id="par0075" class="elsevierStylePara elsevierViewall">The greatest limitation of our series was that we did not determine monozygosity between donors and recipients; we simply analysed the blood group and HLA identities, estimating the possibility of monozygosity, because in the transplants performed before 2000, possible genetic variability was not taken into account, and in the last transplant, the DNA fingerprinting technique was not routinely performed in our laboratory.</p><p id="par0080" class="elsevierStylePara elsevierViewall">In summary, living donor renal transplant between monozygotic twins, though uncommon, can be considered the ideal renal transplant, as it does not require maintenance immunosuppressive therapy. Due to potential immune-system activation, we recommend an intra-operative single dose of steroids to prevent acute rejection, once monozygosity has been demonstrated.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Conflicts of interest</span><p id="par0085" class="elsevierStylePara elsevierViewall">The authors declare no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres580865" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:1 [ "identificador" => "abst0005" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec597370" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres580864" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:1 [ "identificador" => "abst0025" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec597369" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflicts of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-11-02" "fechaAceptado" => "2015-02-01" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec597370" "palabras" => array:3 [ 0 => "Kidney transplant from living donor" 1 => "Immunosuppression" 2 => "Monozygotes" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec597369" "palabras" => array:3 [ 0 => "Trasplante renal de donante vivo" 1 => "Inmunosupresión" 2 => "Monocigotos" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Standard immunosuppression is used in about 60% of patients receiving kidney grafts from their monozygotic twins living donor although an alloimmune response can not take place. The aim of the study was to asses the clinical response in patients receiving renal grafts from a monozygotic twin living donor when no immunosuppressive therapy is used.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Methods</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">This is a retrospective observational study of patients receiving kidney grafts from their monozygotic twins from 1969 to 2013. The following data were recorded: age, renal graft recipient's primary disease, renal function, renal survival and overall survival. Immunosuppressive therapy included a single intraoperative dose of methylprednisolone 500 mg and no maintenance immunosuppression.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Results</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Five patients with kidney grafts from their monozygotic twins were dentified in our centre. Mean age at transplantation was 33 years (27–39). One-year overall survival and graft survival were 100%. Mean creatinine level was 0.96<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.2 one year after transplanta tion, and 1.2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.37 mg/dl at most recent follow-up. Two patients died with a functional graft more than 15 years after kidney transplantation (causes were melanoma and cardiovascu lar event respectively). Follow-up was lost in a patient one year after transplantation. Two patients are alive with a functioning graft at 18 months and 42.5 years after transplantation respectively.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conclusion</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Kidney transplantation from a monozygotic twin living donor is associated with excellent clinical outcomes. Immunosuppressive therapy to suppress alloimmune response is probably unnecessary if zygosity has been confirmed.</p></span>" "secciones" => array:4 [ 0 => array:1 [ "identificador" => "abst0005" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Los pacientes trasplantados de riñón de gemelo monocigótico reciben en un 60% de los casos algún tipo de inmunosupresión estándar a pesar de la imposibilidad teórica para generar una respuesta aloinmune. El objetivo de este estudio es evaluar la respuesta clínica de los receptores renales de donante vivo de gemelo monocigoto sin tratamiento inmunosupresor.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Método</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional retrospectivo entre 1969 y 2013 de pacientes trasplantados renales de donante vivo entre gemelos monocigotos. Se ha recogido edad y enfermedad primaria del receptor, función renal, supervivencia renal y global. El protocolo inmunosupresor consistía en la administración de una dosis única intraoperatoria de 500 mg de metilprednisolona sin otra inmunosupresión de mantenimiento.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se identificó a 5 receptores renales de gemelos idénticos en nuestro centro. Edad media en el momento del trasplante 33 años (27-39). La supervivencia a un año de los pacientes y el injerto fue del 100%. La creatinina media al año fue de 0,96<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0,2 y al último seguimiento de 1,2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0,37 mg/dl. Dos pacientes fallecieron con injerto funcional más de 15 años después del trasplante (uno debido a melanoma y otro debido a un evento cardiovascular). Se perdió el seguimiento de un paciente al año del trasplante. Los 2 pacientes restantes están vivos 18 meses y 42,5 años después del trasplante, respectivamente, con injerto funcionante.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusión</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El trasplante renal entre gemelos monocigotos ofrece excelentes resultados clínicos. Probablemente el tratamiento inmunosupresor para inhibir la respuesta aloinmune es innecesario en estos casos cuando se haya comprobado la cigosidad.</p></span>" "secciones" => array:4 [ 0 => array:1 [ "identificador" => "abst0025" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Sánchez-Escuredo A, Barajas A, Revuelta I, Blasco M, Cofan F, Esforzado N, et al. Trasplante renal de donante vivo entre gemelos monocigotos sin inmunosupresión de mantenimiento. Nefrologia. 2015;35:358–362.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">MPGN: membranoproliferative glomerulonephritis; RT: renal transplant.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Year of transplant \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Age at RT \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Primary renal disease \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Creatinine at 1 year (mg/dL) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Proteinuria at 1 year (mg/24<span class="elsevierStyleHsp" style=""></span>h) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Creatinine at last follow-up \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Proteinuria at last follow-up (mg/24<span class="elsevierStyleHsp" style=""></span>h) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Current status 2014 \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">1969 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Unknown origin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">131 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">121 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Functioning graft \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">1975 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Unknown origin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">102 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">130 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Died (22.5 years post-RT with functioning graft) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">1977 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">MPGN \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">255 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">247 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Died (16 years post-RT with functioning graft) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">1981 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Unknown origin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">78 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">103 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Follow-up in different centre (functioning graft) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">2011 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">39 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Interstitial \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">230 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">126 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Functioning graft \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab947900.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Population characteristics.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:22 [ 0 => array:3 [ "identificador" => "bib0115" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Kidney transplantation between 7 pairs of identical twins" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.E. Murray" 1 => "J.P. Merrill" 2 => "J.H. Harrison" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Ann Surg" "fecha" => "1958" "volumen" => "148" "paginaInicial" => "343" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/13571912" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0120" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Renal transplantation between identical twins" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J.B. Dossetor" 1 => "K.J. Mackinnon" 2 => "J.C. Luke" 3 => "R.O. Mogen" 4 => "J.C. Beck" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S2215-0366(15)00267-9" "Revista" => array:5 [ "tituloSerie" => "Lancet" "fecha" => "1960" "volumen" => "2" "paginaInicial" => "572" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26303534" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0125" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Kidney transplantation in identical twins" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.G. Menville" 1 => "J.U. Schlegel" 2 => "A.M. Pratt II" 3 => "Creecho Jr." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J La State Med Soc" "fecha" => "1961" "volumen" => "113" "paginaInicial" => "173" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/13769507" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0130" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Kidney transplant between identical twins" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C.V. Hodges" 1 => "D.E. Pickering" 2 => "J.E. Murray" 3 => "W.E. Goodwin" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Urol" "fecha" => "1963" "volumen" => "89" "paginaInicial" => "115" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/13963776" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0135" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transplantation of a kidney from an identical twin" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M.F. Woodruff" 1 => "J.S. Robson" 2 => "J.A. Ross" 3 => "B. Nolan" 4 => "A.T. Lambie" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Lancet" "fecha" => "1961" "volumen" => "10" "paginaInicial" => "1245" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0140" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Renal transplantation in identical twins in United States and United Kingdom" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "N. Kessaris" 1 => "D. Mukherjee" 2 => "P. Chandak" 3 => "N. Mamode" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/TP.0b013e31818bd83d" "Revista" => array:6 [ "tituloSerie" => "Transplantation" "fecha" => "2008" "volumen" => "86" "paginaInicial" => "1572" "paginaFinal" => "1577" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19077892" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0145" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Renal transplantation: a twenty-five year experience" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.E. Murray" 1 => "N.L. Tilney" 2 => "R.E. Wilson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Ann Surg" "fecha" => "1976" "volumen" => "184" "paginaInicial" => "565" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/791162" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0150" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Immunosuppression of the living-donor recipient" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J. Pascual" 1 => "D. Hernández Marrero" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3265/Nefrologia.pre2010.Nov.10694" "Revista" => array:7 [ "tituloSerie" => "Nefrologia" "fecha" => "2010" "volumen" => "30" "numero" => "Suppl. 2" "paginaInicial" => "80" "paginaFinal" => "84" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21183966" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0155" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Renal isotransplantation without immunosuppression" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "R. Weil 3rd" 1 => "T.E. Starzl" 2 => "K.A. Porter" 3 => "M. Kershaw" 4 => "G.P. Schroter" 5 => "L.J. Corp." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Surg" "fecha" => "1980" "volumen" => "192" "paginaInicial" => "108" "paginaFinal" => "110" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6996622" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0160" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.G. Hall" 1 => "E. Lopez-Rangel" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:4 [ "titulo" => "Twins and twinning" "paginaInicial" => "395" "paginaFinal" => "404" "serieFecha" => "1966" ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0165" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Living related kidney transplantation between identical twins" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Gumprich" 1 => "G. Woeste" 2 => "K. Kohlhaw" 3 => "J.T. Epplen" 4 => "W.O. Bechstein" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Transplant Proc" "fecha" => "2002" "volumen" => "34" "paginaInicial" => "2205" "paginaFinal" => "2206" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12270364" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0170" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Monozygotic transplantation: concerns and opportunities" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "N. Krishnan" 1 => "P.M. Buchanan" 2 => "N. Dzebisashvili" 3 => "H. Xiao" 4 => "M.A. Schinitzler" 5 => "D.C. Brennan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1600-6143.2008.02378.x" "Revista" => array:6 [ "tituloSerie" => "Am J Transplant" "fecha" => "2008" "volumen" => "8" "paginaInicial" => "2343" "paginaFinal" => "2351" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18808409" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0175" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mechanisms for differences in monozygous twins" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "P. Gringras" 1 => "W. Chen" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Early Hum Dev" "fecha" => "2001" "volumen" => "64" "numero" => "2" "paginaInicial" => "105" "paginaFinal" => "117" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11440823" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0180" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cost-effectiveness analysis of renal replacement therapy in Austria" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Haller" 1 => "G. Gutjahr" 2 => "R. Kramar" 3 => "F. Harnoncourt" 4 => "R. Oberbauer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/ndt/gfq780" "Revista" => array:6 [ "tituloSerie" => "Nephrol Dial Transplant" "fecha" => "2011" "volumen" => "26" "paginaInicial" => "2988" "paginaFinal" => "2995" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21310740" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0185" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Available from: <a href="http://www.unos.org/">www.unos.org</a>" ] ] ] 15 => array:3 [ "identificador" => "bib0190" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The danger model: a renewed sense of self" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "P. Matzinger" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1126/science.1071059" "Revista" => array:6 [ "tituloSerie" => "Science" "fecha" => "2002" "volumen" => "296" "paginaInicial" => "301" "paginaFinal" => "305" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11951032" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0195" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hypertensinogenic mechanism of the calcineurin inhibitors" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.J. Curtis" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Curr Hypertens Rep" "fecha" => "2002" "volumen" => "4" "numero" => "5" "paginaInicial" => "377" "paginaFinal" => "380" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12217256" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0200" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pro- and anti-cancer effects of immunosuppressive agents used in organ transplantation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Guba" 1 => "C. Graeb" 2 => "K.W. Jauch" 3 => "E.K. Geissler" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Transplantation" "fecha" => "2004" "volumen" => "77" "paginaInicial" => "1777" "paginaFinal" => "1782" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15223891" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0205" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Melanoma: diagnosis, staging and treatment. Consensus group recommendations" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Berrocal" 1 => "L. Cabañas" 2 => "E. Esinosa" 3 => "R. Fernández-de-Misa" 4 => "S. Martín-Algarra" 5 => "J.C. Martínez-Cedres" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s12325-014-0148-2" "Revista" => array:7 [ "tituloSerie" => "Adv Ther" "fecha" => "2014" "volumen" => "31" "numero" => "9" "paginaInicial" => "945" "paginaFinal" => "960" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25145549" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0210" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Twin zygosity testing for medical purposes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "D.M. Clair" 1 => "J.B. Clair" 2 => "C.P. Swainson" 3 => "F. Bamforth" 4 => "G.A. Machin" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Am J Med Genet" "fecha" => "1998" "volumen" => "77" "paginaInicial" => "412" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9632172" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0215" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Non-identical monozygotic twins, intermediate twin types, zygosity testing and the non-random nature of monozygotic twinning: a review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "G. Machin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/ajmg.c.30212" "Revista" => array:5 [ "tituloSerie" => "Am J Med Genet C Semin Med Genet" "fecha" => "2009" "volumen" => "151C" "paginaInicial" => "110" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19363805" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0220" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transplantation between monozygotic twins: how identical are they?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "E. Day" 1 => "P.K. Kearns" 2 => "C.J. Taylor" 3 => "J.A. Bradley" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/TP.0000000000000274" "Revista" => array:6 [ "tituloSerie" => "Transplantation" "fecha" => "2014" "volumen" => "98" "paginaInicial" => "485" "paginaFinal" => "489" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25102303" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000003500000004/v1_201511210014/S2013251415000577/v1_201511210014/en/main.assets" "Apartado" => array:4 [ "identificador" => "42660" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003500000004/v1_201511210014/S2013251415000577/v1_201511210014/en/main.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251415000577?idApp=UINPBA000064" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 7 | 9 | 16 |
| 2024 October | 52 | 41 | 93 |
| 2024 September | 53 | 30 | 83 |
| 2024 August | 70 | 61 | 131 |
| 2024 July | 43 | 30 | 73 |
| 2024 June | 62 | 37 | 99 |
| 2024 May | 82 | 38 | 120 |
| 2024 April | 41 | 28 | 69 |
| 2024 March | 51 | 24 | 75 |
| 2024 February | 41 | 31 | 72 |
| 2024 January | 40 | 24 | 64 |
| 2023 December | 25 | 26 | 51 |
| 2023 November | 53 | 25 | 78 |
| 2023 October | 40 | 30 | 70 |
| 2023 September | 31 | 32 | 63 |
| 2023 August | 23 | 20 | 43 |
| 2023 July | 50 | 24 | 74 |
| 2023 June | 41 | 12 | 53 |
| 2023 May | 50 | 35 | 85 |
| 2023 April | 35 | 11 | 46 |
| 2023 March | 55 | 18 | 73 |
| 2023 February | 40 | 23 | 63 |
| 2023 January | 52 | 14 | 66 |
| 2022 December | 60 | 30 | 90 |
| 2022 November | 58 | 21 | 79 |
| 2022 October | 51 | 44 | 95 |
| 2022 September | 32 | 23 | 55 |
| 2022 August | 55 | 45 | 100 |
| 2022 July | 40 | 40 | 80 |
| 2022 June | 40 | 29 | 69 |
| 2022 May | 33 | 39 | 72 |
| 2022 April | 44 | 45 | 89 |
| 2022 March | 46 | 37 | 83 |
| 2022 February | 42 | 34 | 76 |
| 2022 January | 79 | 27 | 106 |
| 2021 December | 76 | 43 | 119 |
| 2021 November | 74 | 40 | 114 |
| 2021 October | 82 | 32 | 114 |
| 2021 September | 66 | 37 | 103 |
| 2021 August | 65 | 39 | 104 |
| 2021 July | 70 | 30 | 100 |
| 2021 June | 60 | 37 | 97 |
| 2021 May | 83 | 37 | 120 |
| 2021 April | 135 | 46 | 181 |
| 2021 March | 79 | 35 | 114 |
| 2021 February | 79 | 16 | 95 |
| 2021 January | 41 | 14 | 55 |
| 2020 December | 65 | 9 | 74 |
| 2020 November | 68 | 15 | 83 |
| 2020 October | 30 | 16 | 46 |
| 2020 September | 46 | 8 | 54 |
| 2020 August | 48 | 11 | 59 |
| 2020 July | 68 | 20 | 88 |
| 2020 June | 81 | 8 | 89 |
| 2020 May | 73 | 10 | 83 |
| 2020 April | 64 | 20 | 84 |
| 2020 March | 80 | 16 | 96 |
| 2020 February | 67 | 19 | 86 |
| 2020 January | 75 | 23 | 98 |
| 2019 December | 125 | 30 | 155 |
| 2019 November | 124 | 19 | 143 |
| 2019 October | 113 | 17 | 130 |
| 2019 September | 131 | 18 | 149 |
| 2019 August | 74 | 25 | 99 |
| 2019 July | 48 | 33 | 81 |
| 2019 June | 58 | 28 | 86 |
| 2019 May | 55 | 24 | 79 |
| 2019 April | 93 | 26 | 119 |
| 2019 March | 46 | 26 | 72 |
| 2019 February | 26 | 12 | 38 |
| 2019 January | 22 | 17 | 39 |
| 2018 December | 402 | 42 | 444 |
| 2018 November | 352 | 20 | 372 |
| 2018 October | 382 | 21 | 403 |
| 2018 September | 195 | 18 | 213 |
| 2018 August | 92 | 16 | 108 |
| 2018 July | 90 | 13 | 103 |
| 2018 June | 113 | 17 | 130 |
| 2018 May | 98 | 15 | 113 |
| 2018 April | 178 | 11 | 189 |
| 2018 March | 122 | 7 | 129 |
| 2018 February | 170 | 6 | 176 |
| 2018 January | 82 | 9 | 91 |
| 2017 December | 171 | 9 | 180 |
| 2017 November | 57 | 10 | 67 |
| 2017 October | 37 | 8 | 45 |
| 2017 September | 40 | 9 | 49 |
| 2017 August | 32 | 9 | 41 |
| 2017 July | 40 | 14 | 54 |
| 2017 June | 41 | 7 | 48 |
| 2017 May | 39 | 14 | 53 |
| 2017 April | 22 | 7 | 29 |
| 2017 March | 49 | 18 | 67 |
| 2017 February | 35 | 26 | 61 |
| 2017 January | 21 | 12 | 33 |
| 2016 December | 70 | 7 | 77 |
| 2016 November | 80 | 33 | 113 |
| 2016 October | 90 | 6 | 96 |
| 2016 September | 153 | 15 | 168 |
| 2016 August | 180 | 4 | 184 |
| 2016 July | 169 | 11 | 180 |
| 2016 June | 106 | 0 | 106 |
| 2016 May | 115 | 0 | 115 |
| 2016 April | 133 | 0 | 133 |
| 2016 March | 121 | 0 | 121 |
| 2016 February | 116 | 0 | 116 |
| 2016 January | 108 | 0 | 108 |
| 2015 December | 138 | 0 | 138 |
| 2015 November | 133 | 0 | 133 |
| 2015 October | 119 | 0 | 119 |
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