Letter to the Editor
Switch to belatacept in kidney graft recipients
Cambio a belatacept en trasplante renal
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Ludivina Robles-Osorio, Pablo García-Solís, Juan Carlos Solís-Sainz, Diana Montero-Perea, Itzel Avilés-Romo, Elizabeth Sabath-Silva, Angeles Ochoa-Martínez, Iván Pérez-Maldonado, Ernesto Sabath" "autores" => array:9 [ 0 => array:2 [ "nombre" => "Ma. 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López-Oliva, Laura Álvarez, Mª Luisa Testillano, Tamara Pérez, María Fernández Nieto, Mª José Santana, Elena González, Alicia Herrero, Rafael Selgas, Carlos Jiménez" "autores" => array:10 [ 0 => array:4 [ "nombre" => "María O." "apellidos" => "López-Oliva" "email" => array:1 [ 0 => "mlopezo@salud.madrid.org" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Laura" "apellidos" => "Álvarez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Mª Luisa" "apellidos" => "Testillano" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Tamara" "apellidos" => "Pérez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "María Fernández" "apellidos" => "Nieto" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "Mª José" "apellidos" => "Santana" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 6 => array:3 [ "nombre" => "Elena" "apellidos" => "González" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 7 => array:3 [ "nombre" => "Alicia" "apellidos" => "Herrero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 8 => array:3 [ "nombre" => "Rafael" "apellidos" => "Selgas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 9 => array:3 [ "nombre" => "Carlos" "apellidos" => "Jiménez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Nephrology Department, University Hospital La Paz, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Pharmacy Department, University Hospital La Paz, Madrid, Spain" "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" => "Cambio a belatacept en trasplante renal" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Calcineurin inhibitors (CNIs) are the gold standard immunosuppression in kidney transplant recipients. These drugs have shown better results in graft survival and patient outcome during the first year after transplantation. However, long-term use is associated with acute and chronic nephrotoxicity, which predisposes to graft loss.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Belatacept is a fusion protein binding to CD80 or CD86 ligands on antigen presenting cells that selectively blocks T-cell costimulatory signals. Data derived from two phase III trials (BENEFIT and BENEFIT-EXT) demonstrated the efficacy and safety of Belatacept in combination with Basiliximab, steroids and mycophenolic acid preventing graft acute rejection in Epstein–Barr virus positive recipients. Recently, the results of BENEFIT and BENEFIT-EXT study after 7 year follow up confirmed former data and showed a significant reduction in death and graft loss associated with the use of belatacept.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Given the relevance of its beneficial effects in kidney function, some authors have proposed switching CNIs into belatacept treatment in intolerant patients to calcineurin or mTOR inhibitors showing an improvement in renal function.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2–5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In our country, the administration of Belatacept is restricted by public health insurance. Public hospitals may use belatacept after individualized assessment requiring specific approval by internal committees in each case.</p><p id="par0025" class="elsevierStylePara elsevierViewall">We summarize (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>) our clinical experience of switching to belatacept in 5 kidney transplant recipients through 2013–2015 after failure or intolerant therapy to tacrolimus and/or everolimus. All patients were Epstein–Barr virus positive.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Pre-transplant kidney biopsies were not performed. Clinical data were compatible with suboptimal donors, predisposing to a recipient poorer renal function. After transplantation patients received immunosuppression therapy consisting of anti-lymphocyte depleting antibodies, steroids and mycophenolic acid postponing tacrolimus starting to minimize delayed graft function. In four patients (cases 2, 3, 4 and 5) renal function was not adequate in the first month post-transplant. Analysis of graft biopsy showed CNI toxicity and chronic vascular lesions (likely related with donor background), but no evidence of acute rejection. Everolimus was considered an alternative to tacrolimus in all four cases. However it was not tolerated because of proteinuria or bone pain. In case 1 the reason for graft dysfunction was a thrombotic microangiopathy (TMA) due to the sequential use of tacrolimus first and cyclosporine later. They were converted to belatacept between 2 and 8 months post-transplantation showing immediate improvement of kidney function. Furthermore, anti HLA antibodies were negative after one year post-conversion.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Patients with low immunological risk (cases 1, 3, 4 and 5) received belatacept at a less intense dosage<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> and in case 2 the dosage of belatacept was more intense<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> due to positive class I anti-HLA antibodies (no donor specific antibodies).</p><p id="par0040" class="elsevierStylePara elsevierViewall">All together, switching to belatacept is effective and safe in patients with failure therapy and/or intolerant to calcineurin or mTOR inhibitors at distinct time periods since transplantation. Moreover, belatacept was associated with better kidney function with no adverse events at short term and is an excellent alternative in grafts with renal dysfunction due to chronic vascular lesions or to CNI-TMA. This positive experience requires long-term assessments to confirm improvement in graft outcome.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">ECD, expanded criteria donor; DCD, donor after circulatory death; ARF, Acute renal failure; IS, immunosuppression; Tx, transplantation; TMA, thrombotic microangiopathy; CNI, calcineurin inhibitors; HTN, arterial hypertension; ATN, acute tubular necrosis; IFTA, interstitial fibrosis and tubular atrophy; Tacro, Tacrolimus; Cyclo, Cyclosporine; Ever, Everolimus; MMF, mycophenolate mofetil; NA, not available.</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 " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black"></th><th class="td" title="table-head " colspan="5" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Patients</th></tr><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Case 1 \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">Case 2 \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">Case 3 \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">Case 4 \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">Case 5 \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 " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Donor</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Age–yr \t\t\t\t\t\t\n \t\t\t\t</td><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="left" valign="top">49 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">54 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">44 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">73 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>ECD/DCD/ARF \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes/No/No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No/No/Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No/No/No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No/Yes/Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes/No/No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Recipient</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Age - yr \t\t\t\t\t\t\n \t\t\t\t</td><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="left" valign="top">54 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">52 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">60 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Induction therapy</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Polyclonal ATG \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Polyclonal ATG \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Polyclonal ATG \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Thymoglobulin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Thymoglobulin \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><br><span class="elsevierStyleItalic">IS maintenance therapy</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><br>Steroids, MMF, Tacro 1st, Cyclo 2nd \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><br>Steroids, MMF, Tacro \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><br>Steroids, MMF, Tacro 1st, Ever 2nd \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><br>Steroids, MMF, Tacro 1st, Cyclo 2nd \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><br>Steroids, MMF, Tacro \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><br><span class="elsevierStyleItalic">Renal histology lesions prior to belatacept switch</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><br>TMA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><br>Vascular lesions, benign HTN \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><br>Vascular lesions, CNI toxicity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><br>Extensive ATN \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><br>Vascular lesions, IFTA, CNI toxicity \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Time from Tx to switch (months)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Anti HLA antibodies</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Pre-conversion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Positive (class I) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Negative \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Post-conversion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Negative \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Creatinine (mg/dl)/CKD-EPI (ml/min)</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Pre-conversion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5.4/11.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3/25.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.5/24.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.1/25.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.3/19 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>6<span class="elsevierStyleHsp" style=""></span>m post-conversion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.29/30.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.1/35.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.5/35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.9/47 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.7/25 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>12<span class="elsevierStyleHsp" style=""></span>m post-conversion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.4/28.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.7/42 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.5/35.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.86/47 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.5/27 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Proteinuria (g/24</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">h)</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Pre-conversion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.42 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>6<span class="elsevierStyleHsp" style=""></span>m post \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.45 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>12<span class="elsevierStyleHsp" style=""></span>m post \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.07 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.29 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Acute rejection post-conversion</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1536014.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Description clinical cases.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Belatacept and long-term outcomes in kidney transplantation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F. Vincenti" 1 => "L. Rostaing" 2 => "J. Grinyo" 3 => "K. Rice" 4 => "S. Steinberg" 5 => "L. Gaite" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa1506027" "Revista" => array:7 [ "tituloSerie" => "N Engl J Med" "fecha" => "2016" "volumen" => "374" "paginaInicial" => "333" "paginaFinal" => "343" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26816011" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0165032715308831" "estado" => "S300" "issn" => "01650327" ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Conversion to belatacept-based immunosuppression therapy in renal transplant patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Paz" 1 => "J. Roberti" 2 => "F. Mos" 3 => "F. Cicora" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.transproceed.2014.07.003" "Revista" => array:6 [ "tituloSerie" => "Transplant Proc" "fecha" => "2014" "volumen" => "46" "paginaInicial" => "2987" "paginaFinal" => "2990" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25420807" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Safe conversion from tacrolimus to belatacept in high immunologic risk kidney transplant recipients with allograft dysfunction" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Gupta" 1 => "A. Regmi" 2 => "D. Kumar" 3 => "S. Posner" 4 => "M.P. Posner" 5 => "A. Sharma" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Am J Transpl" "fecha" => "2015" "volumen" => "15" "paginaInicial" => "2726" "paginaFinal" => "2731" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of an early switch to belatacept among CNI-intolerant graft recipients of kidneys from extended criteria donors" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Y. Le Meur" 1 => "F. Aulagnon" 2 => "D. Bertrand" 3 => "A.E. Heng" 4 => "S. Lavaud" 5 => "S. Caillard" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Am J Transpl" "fecha" => "2016" "volumen" => "16" "paginaInicial" => "2181" "paginaFinal" => "2186" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Switching from calcineurin inhibitor-based regimens to a belatacept-based regimen in renal transplant recipients: a randomized phase II study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L. Rostaing" 1 => "P. Massari" 2 => "V.D. Garcia" 3 => "E. Mancilla-Urrea" 4 => "G. Nainan" 5 => "M. Del Carmen Rial" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2215/CJN.05840710" "Revista" => array:6 [ "tituloSerie" => "Clin J Am Soc Nephrol" "fecha" => "2011" "volumen" => "6" "paginaInicial" => "430" "paginaFinal" => "439" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21051752" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000003700000005/v2_201710131456/S2013251417300664/v2_201710131456/en/main.assets" "Apartado" => array:4 [ "identificador" => "35436" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003700000005/v2_201710131456/S2013251417300664/v2_201710131456/en/main.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251417300664?idApp=UINPBA000064" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 4 | 8 |
| 2024 October | 44 | 24 | 68 |
| 2024 September | 52 | 22 | 74 |
| 2024 August | 58 | 61 | 119 |
| 2024 July | 29 | 14 | 43 |
| 2024 June | 48 | 28 | 76 |
| 2024 May | 47 | 24 | 71 |
| 2024 April | 51 | 26 | 77 |
| 2024 March | 31 | 23 | 54 |
| 2024 February | 27 | 34 | 61 |
| 2024 January | 34 | 24 | 58 |
| 2023 December | 26 | 27 | 53 |
| 2023 November | 33 | 48 | 81 |
| 2023 October | 27 | 36 | 63 |
| 2023 September | 41 | 33 | 74 |
| 2023 August | 29 | 21 | 50 |
| 2023 July | 33 | 20 | 53 |
| 2023 June | 56 | 24 | 80 |
| 2023 May | 73 | 33 | 106 |
| 2023 April | 20 | 18 | 38 |
| 2023 March | 23 | 20 | 43 |
| 2023 February | 30 | 18 | 48 |
| 2023 January | 22 | 23 | 45 |
| 2022 December | 44 | 29 | 73 |
| 2022 November | 42 | 30 | 72 |
| 2022 October | 32 | 44 | 76 |
| 2022 September | 29 | 29 | 58 |
| 2022 August | 39 | 56 | 95 |
| 2022 July | 31 | 44 | 75 |
| 2022 June | 25 | 40 | 65 |
| 2022 May | 39 | 48 | 87 |
| 2022 April | 26 | 50 | 76 |
| 2022 March | 42 | 54 | 96 |
| 2022 February | 30 | 44 | 74 |
| 2022 January | 33 | 36 | 69 |
| 2021 December | 45 | 45 | 90 |
| 2021 November | 32 | 39 | 71 |
| 2021 October | 41 | 67 | 108 |
| 2021 September | 30 | 35 | 65 |
| 2021 August | 34 | 47 | 81 |
| 2021 July | 36 | 29 | 65 |
| 2021 June | 23 | 31 | 54 |
| 2021 May | 29 | 48 | 77 |
| 2021 April | 87 | 108 | 195 |
| 2021 March | 38 | 29 | 67 |
| 2021 February | 35 | 23 | 58 |
| 2021 January | 31 | 19 | 50 |
| 2020 December | 28 | 19 | 47 |
| 2020 November | 29 | 19 | 48 |
| 2020 October | 18 | 27 | 45 |
| 2020 September | 26 | 21 | 47 |
| 2020 August | 34 | 16 | 50 |
| 2020 July | 15 | 12 | 27 |
| 2020 June | 22 | 21 | 43 |
| 2020 May | 37 | 16 | 53 |
| 2020 April | 26 | 20 | 46 |
| 2020 March | 30 | 15 | 45 |
| 2020 February | 22 | 15 | 37 |
| 2020 January | 31 | 19 | 50 |
| 2019 December | 42 | 24 | 66 |
| 2019 November | 38 | 24 | 62 |
| 2019 October | 53 | 21 | 74 |
| 2019 September | 30 | 17 | 47 |
| 2019 August | 40 | 17 | 57 |
| 2019 July | 20 | 21 | 41 |
| 2019 June | 25 | 28 | 53 |
| 2019 May | 27 | 19 | 46 |
| 2019 April | 101 | 32 | 133 |
| 2019 March | 30 | 27 | 57 |
| 2019 February | 30 | 25 | 55 |
| 2019 January | 22 | 25 | 47 |
| 2018 December | 93 | 36 | 129 |
| 2018 November | 203 | 17 | 220 |
| 2018 October | 114 | 12 | 126 |
| 2018 September | 41 | 18 | 59 |
| 2018 August | 28 | 9 | 37 |
| 2018 July | 25 | 13 | 38 |
| 2018 June | 29 | 11 | 40 |
| 2018 May | 44 | 14 | 58 |
| 2018 April | 32 | 16 | 48 |
| 2018 March | 29 | 8 | 37 |
| 2018 February | 25 | 6 | 31 |
| 2018 January | 17 | 7 | 24 |
| 2017 December | 31 | 9 | 40 |
| 2017 November | 29 | 10 | 39 |
| 2017 October | 35 | 9 | 44 |
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