Letter to the Editor – Brief Case Reports
Overall outcomes in kidney transplant recipients with hepatitis C in a district hospital in Camagüey, Cuba
Evolución general de receptores de trasplante renal con hepatitis C, en el hospital provincial de Camagüey, Cuba
Dashiel Millet Torresa, Leonardo Curbelo Rodríguezb, Francisco Ávila Riopedreb, Milene Benítez Méndezc, Francisco Prieto Garcíad,
Corresponding author
a Servicio de Nefrología, Hospital Municipal Nuevitas, Camagüey, Cuba
b Servicio de Nefrología, Hospital Universitario Manuel Ascunce Doménech, Camagüey, Cuba
c Servicio de Medicina General Integral, Hospital Universitario Manuel Ascunce Doménech, Camagüey, Cuba
d Área Académica de Ciencias Ambientales, Universidad Autónoma del Estado de Hidalgo, Pachuca, Hidalgo, Mexico
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"referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 4 => array:4 [ "nombre" => "Francisco" "apellidos" => "Prieto García" "email" => array:2 [ 0 => "prietog@uaeh.edu.mx" 1 => "prietogmx@yahoo.com.mx" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital Municipal Nuevitas, Camagüey, Cuba" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital Universitario Manuel Ascunce Doménech, Camagüey, Cuba" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Medicina General Integral, Hospital Universitario Manuel Ascunce Doménech, Camagüey, Cuba" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Área Académica de Ciencias Ambientales, Universidad Autónoma del Estado de Hidalgo, Pachuca, Hidalgo, Mexico" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Evolución general de receptores de trasplante renal con hepatitis C, en el hospital provincial de Camagüey, Cuba" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Infection with the hepatitis C virus (HCV) is one of the main problems that can negatively affect the outcomes of renal transplant (RT).<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> With new immunosuppressors, short-term outcomes have improved. However, the longer-term prognosis does not run a parallel course and there is some disagreement about how to improve survival rates and outcomes in these patients. These facts could be explained, at least partly, by the barrier caused by HCV infection.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a> In RT patients, HCV can alter the course of liver disease and cast a shadow over the prognosis of these patients.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">It has been reported that the primary cause of RT loss in late stages is death in patients with a functioning graft, while death due to liver disease is, in almost all the reports, between the fourth and fifth cause of death in this population. Renal recipients with HCV have been shown to have a higher incidence of severe opportunistic infections, post-transplant diabetes mellitus, and glomerular diseases, including chronic graft nephropathy. Liver failure is responsible for 8–28% of deaths in the long-term in RT.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">It is known that 7–24% of RT recipients have biochemical abnormalities in liver function. 50% of these abnormalities arise from infection with hepatitis B virus, cytomegalovirus, or Epstein–Barr virus; toxic processes due to drugs such as azathioprine, mycophenolate mofetil, cyclosporine A, and tacrolimus; as well as alcohol abuse, haemosiderosis, and neoplastic disease affecting the liver. The other 50% of liver disease in patients with a renal allograft is caused by HCV.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a> It is important to highlight that between 70% and 95% of transplant patients with HCV have active infection, probably due to immunosuppressive treatment.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Infection with HCV is common in patients with end-stage renal failure on haemodialysis, and the prevalence ranges from 10% to 65%, depending on the geographic area. In France, the prevalence is 10.4% of patients enrolled in dialysis programmes, while in the United States, Japan, and Italy, the prevalence reaches 14%, 14.8%, and 20.6%, respectively.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a> In Spain, 30% of chronic renal patients awaiting RT of have positive hepatitis C virus antibodies (anti-HCV+). According to the Spanish Registry of Chronic Graft Nephropathy, in recent years, the prevalence of this infection has decreased significantly in transplant patients (6%), contributing to better outcomes in the longer-term.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">6</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In countries where infection is endemic (Egypt, Japan, and counties in Southeast Asia), approximately 50% of the dialysis population is infected. Even in countries with a low prevalence of HCV, such as England and New Zealand, the rate ranges between 3% and 5%, representing a rate 10 times higher than that of the general population.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In Latin America, the prevalence of HCV in haemodialysis is variable. In Mexico, Brazil, and Colombia, it is 67%, 52%, and 53%, respectively. In Cuba, 52% of patients receiving haemodialysis are HCV-positive.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a> In the Haemodialysis unit of the <span class="elsevierStyleItalic">Hospital de Camagüey</span> (Cuba), half of the patients are infected with HCV at between 6 and 12 months after starting haemodialysis. The most common risk factors are blood transfusion and re-use of dialysers. Currently, the prevalence of HCV in haemodialysis is 58.66%, and in patients described as suitable for RT, 63% have HCV acquired during haemodialysis.</p><p id="par0035" class="elsevierStylePara elsevierViewall">A cohort study was conducted to compare the general outcomes of RT recipients with HCV acquired during haemodialysis, against recipients without HCV, in the Renal Medicine Department of the <span class="elsevierStyleItalic">Hospital Universitario Manuel Ascunce Domenech de Camagüey</span> (Cuba), in the period from 01/2003 to 12/2012. This population comprises all patients who have received RT, of which 137 patients who met the inclusion criteria were taken as a sample (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">There was a high prevalence of HCV in the transplanted population. There was an increased tendency to develop post-transplant diabetes mellitus and acute rejection in HCV-positive patients. Patient death and acute rejection were the most common causes of loss of graft function. Cardiovascular disease and generalised sepsis were the most common causes of death. In patients with HCV, graft and recipient survival were lower than in those without HCV. Most transplanted patients were 30–40 years old and male (<a class="elsevierStyleCrossRefs" href="#tbl0010">Tables 2 and 3</a>).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Millet Torres D, Curbelo Rodríguez L, Ávila Riopedre F, Benítez Méndez M, Prieto García F. Evolución general de receptores de trasplante renal con hepatitis C, en el hospital provincial de Camagüey, Cuba. Nefrologia. 2015;35:509–511.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "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">Age group \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Male</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Female</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Total</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \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">N.° \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">% \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">N.° \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">% \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">N.° \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">% \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="left" valign="top">15–29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.6 \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="char" valign="top">18.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">30–44 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">36.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">45–59 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">49 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">≥60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">88 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">64.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">49 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">137 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab989882.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Distribution by age and sex. Renal Medicine Department, <span class="elsevierStyleItalic">Hospital Universitario Manuel Ascunce Domenec</span>, Camagüey, 2011–2012.</p>" ] ] 1 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "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="" valign="top" scope="col" style="border-bottom: 2px solid black"> \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">HCV positive \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">% \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">HCV negative \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">% \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="left" valign="top">Died with functioning kidney \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Acute rejection \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Chronic graft dysfunction \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">55.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab989883.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Causes of loss of graft function. Renal Medicine Department, <span class="elsevierStyleItalic">Hospital Universitario Manuel Ascunce Domenech</span>, Camagüey, 2011–2012.</p>" ] ] 2 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "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="" valign="top" scope="col" style="border-bottom: 2px solid black"> \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">HCV positive \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">% \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">HCV negative \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">% \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="left" valign="top">Cardiovascular disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Generalised sepsis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Chronic liver disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.5 \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">1.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Cerebrovascular disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.0 \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">1.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab989884.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Main causes of mortality. Renal Medicine Department, <span class="elsevierStyleItalic">Hospital Universitario Manuel Ascunce Domenech</span>, Camagüey, 2011–2012.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0045" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Outcome of hepatitis B and C virus infection on graft function after renal transplantation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Behzad-Behbahani" 1 => "A. Mojiri" 2 => "S.Z. Tabei" 3 => "A. Farhadi-Andarabi" 4 => "R. Pouransari" 5 => "R. 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Guideline 4: management of HCV-infected patients before and after kidney transplantation" "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "KDIGO" "etal" => false ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Kidney Int" "fecha" => "2008" "volumen" => "73" "numero" => "Suppl. 109" "paginaInicial" => "S53" "paginaFinal" => "S68" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0065" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hepatitis C virus infection and renal transplantation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "F. Fabrizi" 1 => "P. Martín" 2 => "C. 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Levey" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJM199108153250702" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2006" "volumen" => "325" "paginaInicial" => "454" "paginaFinal" => "460" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1649402" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000003500000005/v2_201602120114/S2013251415000929/v2_201602120114/en/main.assets" "Apartado" => array:4 [ "identificador" => "46786" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor - Brief papers about basic research clinical" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003500000005/v2_201602120114/S2013251415000929/v2_201602120114/en/main.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251415000929?idApp=UINPBA000064" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 4 | 8 |
| 2024 October | 22 | 36 | 58 |
| 2024 September | 35 | 24 | 59 |
| 2024 August | 64 | 60 | 124 |
| 2024 July | 27 | 22 | 49 |
| 2024 June | 52 | 30 | 82 |
| 2024 May | 45 | 27 | 72 |
| 2024 April | 38 | 20 | 58 |
| 2024 March | 39 | 25 | 64 |
| 2024 February | 49 | 39 | 88 |
| 2024 January | 46 | 30 | 76 |
| 2023 December | 44 | 25 | 69 |
| 2023 November | 52 | 23 | 75 |
| 2023 October | 61 | 25 | 86 |
| 2023 September | 61 | 19 | 80 |
| 2023 August | 39 | 26 | 65 |
| 2023 July | 51 | 21 | 72 |
| 2023 June | 33 | 21 | 54 |
| 2023 May | 38 | 30 | 68 |
| 2023 April | 32 | 12 | 44 |
| 2023 March | 63 | 21 | 84 |
| 2023 February | 29 | 17 | 46 |
| 2023 January | 23 | 27 | 50 |
| 2022 December | 47 | 28 | 75 |
| 2022 November | 50 | 22 | 72 |
| 2022 October | 47 | 53 | 100 |
| 2022 September | 32 | 21 | 53 |
| 2022 August | 46 | 40 | 86 |
| 2022 July | 31 | 44 | 75 |
| 2022 June | 32 | 37 | 69 |
| 2022 May | 32 | 26 | 58 |
| 2022 April | 29 | 46 | 75 |
| 2022 March | 37 | 36 | 73 |
| 2022 February | 35 | 45 | 80 |
| 2022 January | 31 | 25 | 56 |
| 2021 December | 36 | 39 | 75 |
| 2021 November | 27 | 35 | 62 |
| 2021 October | 40 | 41 | 81 |
| 2021 September | 19 | 28 | 47 |
| 2021 August | 22 | 35 | 57 |
| 2021 July | 36 | 31 | 67 |
| 2021 June | 18 | 24 | 42 |
| 2021 May | 38 | 29 | 67 |
| 2021 April | 61 | 26 | 87 |
| 2021 March | 38 | 31 | 69 |
| 2021 February | 23 | 20 | 43 |
| 2021 January | 26 | 16 | 42 |
| 2020 December | 24 | 12 | 36 |
| 2020 November | 29 | 12 | 41 |
| 2020 October | 18 | 23 | 41 |
| 2020 September | 20 | 10 | 30 |
| 2020 August | 25 | 9 | 34 |
| 2020 July | 29 | 12 | 41 |
| 2020 June | 39 | 7 | 46 |
| 2020 May | 19 | 9 | 28 |
| 2020 April | 31 | 15 | 46 |
| 2020 March | 32 | 14 | 46 |
| 2020 February | 37 | 19 | 56 |
| 2020 January | 41 | 26 | 67 |
| 2019 December | 47 | 34 | 81 |
| 2019 November | 43 | 23 | 66 |
| 2019 October | 39 | 19 | 58 |
| 2019 September | 37 | 25 | 62 |
| 2019 August | 38 | 23 | 61 |
| 2019 July | 31 | 25 | 56 |
| 2019 June | 39 | 26 | 65 |
| 2019 May | 36 | 23 | 59 |
| 2019 April | 49 | 31 | 80 |
| 2019 March | 36 | 18 | 54 |
| 2019 February | 25 | 20 | 45 |
| 2019 January | 31 | 17 | 48 |
| 2018 December | 188 | 47 | 235 |
| 2018 November | 372 | 21 | 393 |
| 2018 October | 257 | 20 | 277 |
| 2018 September | 108 | 16 | 124 |
| 2018 August | 56 | 20 | 76 |
| 2018 July | 69 | 18 | 87 |
| 2018 June | 41 | 12 | 53 |
| 2018 May | 63 | 18 | 81 |
| 2018 April | 88 | 12 | 100 |
| 2018 March | 58 | 4 | 62 |
| 2018 February | 60 | 6 | 66 |
| 2018 January | 67 | 5 | 72 |
| 2017 December | 62 | 6 | 68 |
| 2017 November | 55 | 13 | 68 |
| 2017 October | 23 | 4 | 27 |
| 2017 September | 29 | 11 | 40 |
| 2017 August | 22 | 6 | 28 |
| 2017 July | 26 | 7 | 33 |
| 2017 June | 34 | 11 | 45 |
| 2017 May | 40 | 5 | 45 |
| 2017 April | 30 | 5 | 35 |
| 2017 March | 30 | 34 | 64 |
| 2017 February | 27 | 7 | 34 |
| 2017 January | 13 | 3 | 16 |
| 2016 December | 33 | 10 | 43 |
| 2016 November | 32 | 10 | 42 |
| 2016 October | 76 | 8 | 84 |
| 2016 September | 96 | 3 | 99 |
| 2016 August | 82 | 0 | 82 |
| 2016 July | 117 | 4 | 121 |
| 2016 June | 69 | 0 | 69 |
| 2016 May | 120 | 0 | 120 |
| 2016 April | 70 | 0 | 70 |
| 2016 March | 55 | 0 | 55 |
| 2016 February | 105 | 0 | 105 |
| 2016 January | 76 | 0 | 76 |
| 2015 December | 66 | 0 | 66 |
Show all
