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Kidney transplantation of 32 patients from HLA-incompatible live donors: Efficacy and outcome after desensitization
Trasplante renal procedente de donante vivo HLA incompatible: Eficacia y pronóstico en 32 pacientes tras desensibilización
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In USA, 35% of the patients on the waiting list for renal transplantation are sensibilized and 15% are highly sensibilized.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">1</span></a> Recently, it has been reported that 6% of patients on the waiting list have a 100% of calculated reactivity against the panel.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">2</span></a> In Spain, in 2014, 11.5% of patients on the transplant waiting list are HY.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The remedy for these patients is to use desensitization (DS) techniques, inclusion in either cross-transplant lists (living donor) or in exclusive list of cadaveric donor for sensibilized patients.<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">3–6</span></a> Survival is better in DS patients than in those who remain on the waiting list and are transplanted with a compatible donor and it is even better than those in the list that remain on dialysis.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">7</span></a> Two review manuscripts compare the results of different DS techniques: Immunoglobulins (IgV), high dose IgV, plasmapheresis (PF) or immunoadsorption (IA) with or without IgV, rituximab (RTX), bortezomib, but there is great heterogeneity in: patient selection (live donor versus cadaver), the method used for <span class="elsevierStyleItalic">cross-match</span> selection (complement dependent cytotoxicity [CDC], flow cytometry [FC], specific donor antibodies [SDA] by Luminex), follow up and type of monitorization to assess the response to desensitization. In these groups of transplant patients the rate of rejection varies from 0% to 100% – and depends on the treatment used and the selection criteria. Patient survival ranges from 80 to 100% and graft survival between 69 and 100%. In 2014, Riella et al., using a DS protocol based on PF, IgV and RTX, reported a 61% of antibody-mediated rejection rate, after 5 years the patient survival was 86% and the renal survival was 84%.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">9</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In 2012, within our area of health care, there were only 24 transplanted patients who presented reactivity against the panel of 70%. This group of patients had been in the transplant waiting list for the longest period of time.<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">10</span></a> Only 3 patients were transplanted under the network renal transplant program; the National Plan of Renal Exchange for Hyperimmunized Patients (PATHI) was not started in Spain until 2015. Therefore, taking into consideration the results of the other series above described, we started a DS program in 2007, the objective was to open up the possibility of transplantation to this group of patients. The aim of the present study is to show our results obtained from “A Coruña University Hospital” in patients, with HLA incompatible living donors, who underwent desensitization (DS).</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">The study began in January 2007 and it was completed in 2014. During this period, 100 patients received a kidney transplant from a living donor. We evaluated 32 patients on pre-transplantation DS protocol; 21 of them were on hemodialysis, 5 in peritoneal dialysis, and 6 were in predialysis. All patients had a positive cross-reactivity against their donor as assessed by CDC, FC or Luminex. Prior to the onset of DS, patients and donors were informed about the procedure and gave their official consent form authorized in our center. In addition, the donors signed the consent in court, according to the protocol of live donation.</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Desensitization</span><p id="par0025" class="elsevierStylePara elsevierViewall">The DS protocol consisted in administration of RTX 375<span class="elsevierStyleHsp" style=""></span>mg/m<span class="elsevierStyleSup">2</span> (Roche Farma AG, Grenzach-Wyhlen, Germany) one month prior to transplantation. Tacrolimus, MMF or MFS and prednisone were initiated one week before starting PF/IA. PF or non-specific IA was performed initially on a daily basis, except on Sundays. IA was performed in 19 patients using Therasorb columns, PF in 12 patients and in one patient both procedure were used. After each PF/AI session the patients received specific anti-CMV IgV 100<span class="elsevierStyleHsp" style=""></span>mg/kg (Cytotect Biotest Pharma GmbH, Germany). Hemodialysis was performed every 48<span class="elsevierStyleHsp" style=""></span>h after the apheresis session or 4 daily exchanges of peritoneal dialysis. Once the apheresis sessions were started, we either monitored the antibody count or performed cross-reaction tests. When CDC or FC cross-reaction test was negative and SDA levels reached a mean fluorescence intensity (MFI) of less than 1000, the patient was accepted for transplantation. Once transplanted, PF or IA was performed on days +3, +5 and +8 after transplantation.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Immunosuppression</span><p id="par0030" class="elsevierStylePara elsevierViewall">Induction with basiliximab was performed in 13 patients (56.5%). Tacrolimus levels were set at 10–12<span class="elsevierStyleHsp" style=""></span>ng/ml during the first week, and were reduced progressively to reach 7–8<span class="elsevierStyleHsp" style=""></span>ng/ml from the 6th month. The initial dose of MMF (Cellcept) was 2<span class="elsevierStyleHsp" style=""></span>g/day, followed by reduction of 1<span class="elsevierStyleHsp" style=""></span>g/day per month. The dose of MFS (Myfortic) was 1440<span class="elsevierStyleHsp" style=""></span>mg per day, which was reduced to 720<span class="elsevierStyleHsp" style=""></span>mg/day per month. Prednisone was started at 20<span class="elsevierStyleHsp" style=""></span>mg/day, and it was progressively reduced to 5<span class="elsevierStyleHsp" style=""></span>mg by month 6. Prophylaxis was performed using co-trimoxazole for 6 months, itraconazole for 4–6 months, and valganciclovir (Valcyte; Roche Farma, Madrid, Spain) in CMV donor positive patients, CMV negative receptor (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Follow up</span><p id="par0035" class="elsevierStylePara elsevierViewall">After discharge, patients were followed in the out patient clinic with monitorization of renal function, tacrolimus levels, CMV infection first with pp55 antigenemia and presently using PCR of CMV and BK virus.</p><p id="par0040" class="elsevierStylePara elsevierViewall">If deterioration of renal function was evidenced, a biopsy was obtained and SDA were determined. In our transplant unit protocol biopsies or systematic follow-up of SDA are not performed.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The diagnosis of rejection in the biopsy was made based on Banff classification, adapted to the date in which this classification was published.<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">11,12</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Antibody-mediated rejection was treated with steroids (3 boluses of 500<span class="elsevierStyleHsp" style=""></span>mg for 3 consecutive days), PF or IA, IgV, RTX and eculizumab (in refractory cases). Treatment of T-cell mediated rejection included steroid boluses (3 boluses of 500<span class="elsevierStyleHsp" style=""></span>mg for 3 consecutive days).</p><p id="par0055" class="elsevierStylePara elsevierViewall">Variables evaluated: Efficacy of DS, delayed graft function, acute rejection, graft and patient survival, renal function, number of procedures of PF/IA, MFI against class I and II pre and postapheresis, Number of antibodies against class I and II, relative intensity scale (RIS) as reported by Jordan et al.,<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">10</span></a> CMV and BK infections, diabetes posttransplant, neoplasias and urological complications.</p><p id="par0060" class="elsevierStylePara elsevierViewall">E-statistics analysis: Quantitative variables were compared by Student <span class="elsevierStyleItalic">t</span> test and ANOVA. Mann–Whitney was used to compare variables without normal distribution.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Chi square and Fisher's test was used for qualitative variables. Survival was calculated according to Kaplan–Meier and log rank test. For the multivariate study we used the Cox regression and for the sensitivity and specificity analysis, the ROC curves. The statistical analysis was performed using the program SPSS (version 15.0.1, Chicago, IL, USA).</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Results</span><p id="par0070" class="elsevierStylePara elsevierViewall">The study included 32 patients (15 males), with a mean age of 46<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>14 years. The relationship between donor and recipient was: parent,<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">9</span></a> spouse,<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">14</span></a> sibling,<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">5</span></a> child<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">1</span></a> and others.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">3</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">At baseline, patients presented a number of antibodies against class I: 0.9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.7 (0–3) with MFI 7979<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>40 and class II: 0.6<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.5 (0–2) with MFI 6825<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4182; RIS 8.9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>7.7 (2–30). CDC cross-match was positive in 18 patients; by FC, in 7. Another 7 patients had only SDA using solid phase techniques (Luminex, One Lambda, Thermo Fisher Scientific, Canoga Park, CA, USA). DS was considered effective when CDC and FC cross-tests were negative and the MFI less than 1000 (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">After 8<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3 sessions of PF/IA4-15, it was possible to perform transplantation in 23 patients (71.9%), but in 9 patients the transplant failed. Desensitization was not successful in 9 patients; 8 of these patients presented a previous cross-match by CDC and one by SDA (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.02). Class I MFI and RIS were predictors of efficacy by ROC curves (area of 0.949 and 0.848, respectively). A cutoff point of MFI and RIS was set at 9300 and 8.5 points respectively, with provides 100% sensitivity and 93% specificity for the first and 88% sensitivity and 74% specificity for the second. DS was not effective above these values (<a class="elsevierStyleCrossRefs" href="#fig0010">Figs. 2 and 3</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">In the postoperative period, 13 patients had hematoma-hemorrhage, requiring reintervention in 6 (26%). Blood transfusion was necessary in 16 (69%). In 3 patients (13%) there was a delay the initial function of the graft.</p><p id="par0090" class="elsevierStylePara elsevierViewall">After 43<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>30 months (range 0.1–104) of follow-up, 4 patients (17.4%) had acute rejection; in one patient it was antibody-mediated, in two T-mediated and in the last of four it was mixed (antibodies and T cells mediated rejection). Patients with rejection had a higher baseline MFI, higher values of RIS, and a positive CDC cross-match (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>), but in the Cox analysis, RIS was the only parameter that reached statistical significance.</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Patient survival at 1 and 5 years were 96% and 90% respectively (<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a>). One patient died during sepsis of urinary origin (during the first week postransplantation) and one died after subarachnoid hemorrhage (during the second year). Graft survival was 86% at year 1 and 5 after transplantation (<a class="elsevierStyleCrossRef" href="#fig0030">Fig. 6</a>), being worse in patients with acute rejection mediated by antibodies (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>0.02). The causes of graft loss were antibody-mediated rejection in 2 patients (one of them also had T cell mediated rejection), chronic nephropathy in one patient, and arterial thrombosis in another.</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><elsevierMultimedia ident="fig0030"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">The mean serum creatinine (mg/dl) was 1.2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.3, after one year, 1.4<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.4 the 3rd year and 1.5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.04<span class="elsevierStyleHsp" style=""></span>at the end of the 5 years of follow-up. Mean values of proteinuria (mg/day) at years 1, 3 and 5 post transplantation were 0.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.3, 0.2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.2 and 0.5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.7 respectively</p><p id="par0105" class="elsevierStylePara elsevierViewall">There were six CMV infections (26%) and one BK viremia (4%). The frequency of post-transplant diabetes was 26%,<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">6</span></a> lymphocele 13%<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">3</span></a> and renal artery stenosis 4%.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">1</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">Two post-transplant neoplasia were diagnosed, one chronic lymphatic leukemia and one cutaneous squamous cell carcinoma.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Discussion</span><p id="par0115" class="elsevierStylePara elsevierViewall">Renal transplantation is the best therapeutic option for patients with end stage renal disease.<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">14</span></a> In hypersensitized patients the rate of transplantation is low (<6.5% per year in USA, up to the last year), they remain in the waiting list for long periods of time and the mortality is high. The options of a patient with an incompatible living donor are DS, joining cross-renal donation programs which is valid option if a living donor is available, or being included in special exchange and prioritization programs.<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">3–6</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Our DS protocol is similar to others being used during the last years by different groups. However there is a lot of heterogeneity between the series, especially when defining selection criteria for desensitization and transplantation.<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">1,8</span></a> In our serie, cross-match was positive for CDC in 18 of the 32 patients and it was not possible to desensitize 44% of them. The results were more favorable in those who presented a positive cross-reaction by FC or only with SDA by Luminex, in fact we managed to transplant 100 and 86% of those respectively. Orandi et al. showed that DS improves the prognosis of patients as compared with those who remain on the waiting list and finally are transplanted or those remaining on dialysis. These differences were maintained for any level of baseline DS (CDC+, CF+ or only SDA+ by Luminex), although the prognosis was worse in those with cross-reaction test was positive by CDC,<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">7</span></a> which could mean that these patients positive by CDC have a higher number of antibodies or higher affinity and this allows them to be detected by techniques that are less sensitive with respect to CF or Luminex.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">3</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Another factor that could influence the results is the amount of antibodies, interpreted as the level of MFI, which is not well known in most of the series. We used RIS to homogenize the number of antibodies in each patient and their MFI, as described by Jordan et al.<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">13</span></a> Our results demonstrate that DS was not effective in patients with MFI greater than 9300 in class I, or in those with an RIS greater than 8.5.</p><p id="par0130" class="elsevierStylePara elsevierViewall">In our study, at year 5 the survival of patient (90%) and graft (86%) was similar to that reported by others and illustrate the possibility of performing this type of treatment in HY patients who would otherwise remain for a long time in the waiting list. Marfo et al.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">1</span></a> reports a 95% patient survival and 85% graft survival; Orandi at year 3, 91.7% and at year 8 a 76.5%<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">6</span></a>; Yang et al. in Taiwan,<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">15</span></a> at year 5, they report 100% of the patient and 92.3% of the graft survival; and De Sousa et al., 95.9% of patients and 85% of grafts survived after 5 years.<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">16</span></a> Morath et al.,<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">17</span></a> using PF or AI, reported a 95.8% patient survival and 92.4% graft survival, after one year. Bentall et al.<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">18</span></a> reported a 5-year patient survival rate of 83.5%, lower than in the control group (92.5%) and a graft survival of 70.7%, lower than in the control group (88%), and Thielke et al.<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">19</span></a> showed 95% patient survival and 93% of the graft survival after one year.</p><p id="par0135" class="elsevierStylePara elsevierViewall">The incidence of acute rejection was 17%, in 2 cases antibody-mediated (AMR), one of them also had T-cell mediated rejection with no response to treatment, and 2 other patients had rejections mediated only by T cells, Banff IA, with good response to steroids. In our serie, the probability of rejection was greater in patients with CDC-positive cross-match and in those with higher RIS. Our low frequency of rejection contrasts with others that have reported from 17 to 80% rejections, using different protocols and different degrees of DS (CDC, CF, SDA).<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">1,8</span></a> We do not perform biopsies by protocol and only monitor SDA if there is a suspicion of antibody-mediated rejection, so we may not have detected subclinical rejections or chronic rejections mediated by antibodies, which could explain this difference. Riella et al that uses a DS protocol similar to ours,<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">9</span></a> has reported a 61% rejection; 100% of patients had CDC-positive cross-match pre-transplantation and the monitorization of titers differs from ours in that we used MFI and they used antibody titers; in addition, only 21 of 39 received RTX. After DS with bortezomib, Aubert et al.<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">20</span></a> found no acute rejection after 18 months and Woodle et al.<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">21</span></a> reported 31%. Recently, Moreno Gonzales et al.,<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">2</span></a> using 32 doses of bortezomib only found moderate reduction of antibody without negativization of the cross-match, and it was not well tolerated.</p><p id="par0140" class="elsevierStylePara elsevierViewall">There is little information on the incidence of post-transplant SDA in the series of desensitized patients. Morath et al.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">17</span></a> monitored antibodies during one year and these remained positive at low titers. De Sousa et al.<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">16</span></a> monitored the antibodies in 18 patients, in one of them were positive and developed AMR. Kauke et al.<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">22</span></a> demonstrated that in 6 out of 8 desensitized patients the antibodies persisted and 3 of them developed AMR. Stegall et al.,<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">23</span></a> in patients treated with eculizumab, found that 50% of the patients developed SDA with MFI >10,000, although the incidence of acute rejection was 7.7% as compared with 41.1% in the group without eculizumab. In our series, 8 patients had SDA at follow-up: 3 of them were positive, 2 developed AMR and another patient had transplant glomerulopathy.</p><p id="par0145" class="elsevierStylePara elsevierViewall">In our study, despite the high load of immunosuppression, the rate of infectious complications was acceptable, with an incidence of CMV of 26% and BK of 4%. Vo et al.<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">24</span></a> reported a 16.5% CMV infection and 0% BK viremia. Kauke et al.,<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">22</span></a> reported 2/8 (25%) of BK viremia. Yang et al.<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">15</span></a> reported 3 cases of BK nephropathy (13.6%) and 2 CMV pneumonitis (9%). De Sousa et al.<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">16</span></a> reported 3 CMV reactivations (13%) and one case of BK (4.3%). Morath et al.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">17</span></a> describe 10% CMV and 0% BK. Thielke et al.<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">19</span></a> 7% CMV and 4.9% BK. Stegall et al.<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">23</span></a> used eculizumab without reporting no CMV or BK virus infections.</p><p id="par0150" class="elsevierStylePara elsevierViewall">The incidence of neoplasias is not usually reported. Two patients in our series had de novo neoplasia (a chronic lymphatic leukemia and a skin squamous cell carcinoma). The Taiwan group reported 3 cases of urothelial cancer. Stegall et al., in patients desensitized with eculizumab, reported one case of Burkitt's lymphoma.</p><p id="par0155" class="elsevierStylePara elsevierViewall">A relatively frequent complication following transplantation is the occurrence of hematoma/hemorrhage. It could be related to PF or IA in incompatible ABO transplants due to the loss of coagulation factors, including factor XIII, the decrease in the number of platelets or the use of anticoagulants to perfuse the graft.<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">25–27</span></a> In our patients we did not identify a factor that could favor bleeding (although we did not measure factor XIII), perhaps due to the limited number of patients. There might be a number of factors that acting together may facilitate hemorrhage.</p><p id="par0160" class="elsevierStylePara elsevierViewall">The limitations of our study are the sample size, the absence of protocol biopsy and the low number of SDA monitored. Despite this, the clinical results are acceptable in a group of patients who would have to be maintained on the waiting list for a long time. We detected markers that identify patients in whom DS is ineffective, these are MFI class I or RIS, which would suggest to avoid the initiation a costly treatment with potential adverse effects. We conclude that the HLA DS with the protocol shown in this study is an option to consider in those patients sensitized against a living donor.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Conflict of interests</span><p id="par0165" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres950384" "titulo" => "Abstract" "secciones" => array:2 [ 0 => array:1 [ "identificador" => "abst0005" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec922233" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres950383" "titulo" => "Resumen" "secciones" => array:2 [ 0 => array:1 [ "identificador" => "abst0015" ] 1 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec922232" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Desensitization" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Immunosuppression" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Follow up" ] ] ] 6 => array:2 [ "identificador" => "sec0030" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0035" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflict of interests" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-12-29" "fechaAceptado" => "2017-06-13" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec922233" "palabras" => array:5 [ 0 => "Renal transplantation from HLA-incompatible live donors" 1 => "Desensitization" 2 => "Plasmapheresis" 3 => "Immunoadsorption" 4 => "Rituximab" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec922232" "palabras" => array:5 [ 0 => "Trasplante renal de donante vivo HLA incompatible" 1 => "Desensibilización" 2 => "Plasmaféresis" 3 => "Inmunoadsorción" 4 => "Rituximab" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Desensitization is a procedure undergone by the recipient of a kidney transplant from a donor who is cross-match positive. The aim of this study was to present the outcomes from our hospital of kidney transplant recipients from HLA-incompatible live donors after desensitization.</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We studied 32 patients aged 46<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>14 years with a mean fluorescence intensity (MFI) versus class I HLA of 7979<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4089 and 6825<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4182 MFI versus class II and relative intensity scale (RIS) of 8.9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>7.6. The complement-dependent cytotoxicity (CDC) cross-matching test was positive in 18 patients, flow cytometry was positive in 7 patients and donor-specific antibodies (DEA) were detected in 7. The protocol used was rituximab, plasmapheresis/immunoadsorption, immunoglobulins, tacrolimus, mycophenolic acid derivatives and prednisone.</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">After 8<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3 sessions of plasmapheresis/immunoadsorption, 23 patients were transplanted (71.9%) and desensitization was ineffective in 9. There were baseline differences in MFI class I (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001), RIS (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.008), and CDC cross-matching, DSA and flow cytometry (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.05). MFI class I and RIS were predictors of inefficiency in ROC curves. After follow-up of 43<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>30 months, 13 patients (56%) presented postoperative bleeding, 3 (13%) delayed graft function, 4 (17.4%) acute rejection, 6 (26%) CMV viremia and 1 (4%) BK viremia. Five-year patient survival was 90%, with 86% allograft survival. Five-year creatinine was 1.5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.4 and proteinuria was 0.5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.7.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Kidney transplantation from HLA-incompatible live donors after desensitization was possible in 71.9% of patients. MFI class I and RIS predict the inefficiency of desensitization. Five-year allograft survival (86%) was acceptable with a low incidence of acute rejection (17.4%), although with a greater trend toward postoperative bleeding.</p></span>" "secciones" => array:2 [ 0 => array:1 [ "identificador" => "abst0005" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0015" class="elsevierStyleSection elsevierViewall"><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La desensibilización es un método empleado en trasplante renal para tratar de trasplantar a pacientes que presentan una prueba cruzada positiva frente a su donante. El objetivo del estudio es mostrar los resultados de nuestro hospital en pacientes trasplantados renales con donantes vivos HLA incompatibles, tras un protocolo de desensibilización.</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudiamos a 32 pacientes de 46<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>14 años que presentaban una intensidad media de fluorescencia (MFI) frente a HLA de clase I de 7.979<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4.089 y de 6.825<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4.182 para MFI frente a clase II y <span class="elsevierStyleItalic">relative intensity scale</span> (RIS) de 8,9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>7,6. La prueba cruzada fue positiva por citotoxicidad dependiente del complemento (CDC) en 18 pacientes, citometría de flujo (CF) en 7 y anticuerpos donante específicos (ADE) en 7. El protocolo empleado fue: rituximab, plasmaféresis/inmunoadsorción, inmunoglobulinas, tacrolimus, derivados ácido micofenólico y prednisona.</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Tras 8<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3 sesiones de plasmaféresis/inmunoadsorción se trasplantó a 23 pacientes (71,9%) y resultó ineficaz en 9. Existían diferencias basales en MFI clase I (p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,001), RIS (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,008) y <span class="elsevierStyleItalic">cross-match</span> por CDC, ADE o CF (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,05). El MFI de clase I y el RIS resultaron predictores de eficacia en curvas COR. Tras un seguimiento de 43<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>30 meses, 13 pacientes (56%) presentaron sangrado postoperatorio, 3 (13%) función retrasada injerto, 4 (17,4%) rechazo agudo, 6 (26%) viremia CMV y uno (4%) viremia BK. Al 5.° año, la supervivencia del paciente fue del 90% y la supervivencia renal del 86%. En ese mismo año, la creatinina fue de 1,5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0,4 y la proteinuria de 0,5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0,7.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El trasplante renal de donante vivo HLA incompatible tras la desensibilización fue posible en el 71,9% de los pacientes. MFI de clase I y RIS predicen ineficacia de la desensibilización. La supervivencia renal (86% al 5.° año) es aceptable con baja incidencia de rechazo agudo (17,4%), aunque con una mayor tendencia al sangrado postoperatorio.</p></span>" "secciones" => array:2 [ 0 => array:1 [ "identificador" => "abst0015" ] 1 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Please cite this article as: Fernández C, Calvo M, Leite N, López A, Ferreiro T, Ribera R, et al. Trasplante renal procedente de donante vivo HLA incompatible: Eficacia y pronóstico en 32 pacientes tras desensibilización. Nefrologia. 2017;37:638–645.</p>" ] ] "multimedia" => array:7 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1196 "Ancho" => 2990 "Tamanyo" => 179438 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Pre-transplantation conditioning protocol.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1459 "Ancho" => 2633 "Tamanyo" => 214549 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">ROC curves: MFI class I.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1297 "Ancho" => 2533 "Tamanyo" => 171947 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">ROC curves: RIS.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1495 "Ancho" => 2909 "Tamanyo" => 175643 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Probability of acute rejection.</p>" ] ] 4 => array:7 [ "identificador" => "fig0025" "etiqueta" => "Fig. 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 1378 "Ancho" => 2098 "Tamanyo" => 64453 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Survival of the patient.</p>" ] ] 5 => array:7 [ "identificador" => "fig0030" "etiqueta" => "Fig. 6" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr6.jpeg" "Alto" => 1324 "Ancho" => 2093 "Tamanyo" => 57686 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Graft survival.</p>" ] ] 6 => 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 [ "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">Efficacy: <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>23 \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">Without efficacy: <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>9 \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"><span class="elsevierStyleItalic">p</span> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age of donor (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">50.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">49.6<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \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">Age of recipient (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">48.6<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">38.6<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>12 \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></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dialysis vintage (months) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">84.9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>77 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">39.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>46 \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></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No. of antibodies class I and II \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.47<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.79 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.66<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.70 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \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">MFI class I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5840<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3002 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12,258<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2044 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.001 \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">MFI class II \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6048<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4145 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9169<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3725 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \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">RIS<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6.2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>6.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.005 \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">Pregnancy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.86<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.33<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.07 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \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">No. of HLA incompatibilities \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.7<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \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">Number of PFS/IA sessions \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8.1<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8.7<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \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">Cross-match: CDC/FC/SDA (n°)<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10/7/6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8/0/1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.02 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1609183.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">RIS: relative intensity scale: <5000 MFI<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>2; 5000–10,000<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>5; >10,000<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>10. For each antibody.</p>" ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Cross-match for lymphocytotoxicity (CDC), flow cytometry (FC), Luminex specific donor antibodies (SDA).</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Desensitization efficacy.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:27 [ 0 => array:3 [ "identificador" => "bib0140" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Desensitization protocols and their outcome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "K. Marfo" 1 => "A. Lu" 2 => "M. Ling" 3 => "E. Alcalin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2215/CJN.08140910" "Revista" => array:7 [ "tituloSerie" => "Clin J Am Soc Nephrol" "fecha" => "2011" "volumen" => "6" "paginaInicial" => "922" "paginaFinal" => "936" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21441131" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0749806316309318" "estado" => "S300" "issn" => "07498063" ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0145" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "32 doses of bortezomib for desensitization is not well tolerated and is associated with only modest reductions in anti-HLA antibody" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.A. Moreno Gonzales" 1 => "M.J. Gandhi" 2 => "C.A. Schinstock" 3 => "N. Moore" 4 => "B.H. Smith" 5 => "N.Y. Braaten" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/TP.0000000000001330" "Revista" => array:6 [ "tituloSerie" => "Transplantation" "fecha" => "2017" "volumen" => "101" "paginaInicial" => "1222" "paginaFinal" => "1227" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27379560" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0150" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Approach to the highly sensitized kidney transplant candidate" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D. Keith" 1 => "G. Vranic" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2215/cjn.05930615" "Revista" => array:2 [ "tituloSerie" => "Clin J Am Soc Nephrol" "fecha" => "2016" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0155" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Programa nacional de donación renal cruzada. Version 6.0. Available from: <a href="http://www.ont.es/infesp/Paginas/DocumentosdeConsenso.aspx">http://www.ont.es/infesp/Paginas/DocumentosdeConsenso.aspx</a> [accessed 25.4.15]." ] ] ] 4 => array:3 [ "identificador" => "bib0160" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "PATHI. Programa de acceso trasplante de hiperinmunizados Protocolo basado en prueba cruzada virtual. ONT. Available from: <a href="http://www.ont.es/infes/DocumentosDeConsenso/PROTOCOLO%25PATHI.pdf">http://www.ont.es/infes/DocumentosDeConsenso/PROTOCOLO%PATHI.pdf</a> [accessed 7.6.16]." ] ] ] 5 => array:3 [ "identificador" => "bib0165" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "[Epub online ahead of print]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Early changes in kidney distribution under the new allocation system" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.B. Massie" 1 => "X. Lou" 2 => "B.E. Lonze" 3 => "N.M. Desai" 4 => "A.W. Bingamna" 5 => "M. Cooper" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1681/ASN.2015080934" "Revista" => array:6 [ "tituloSerie" => "J Am Soc Nephrol" "fecha" => "2016" "volumen" => "27" "paginaInicial" => "2495" "paginaFinal" => "2501" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26677865" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0170" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Survival benefit with kidney transplants from HLA-incompatible live donors" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B.J. Orandi" 1 => "X. Luo" 2 => "A.B. Massie" 3 => "J.M. Garonzik-Wang" 4 => "B.E. Lonze" 5 => "R. Ahmed" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "N Eng J Med" "fecha" => "2016" "volumen" => "374" "paginaInicial" => "940" "paginaFinal" => "950" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0175" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Desensitization in kidney transplantation: review and future perspectives" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A. Jawdeh" 1 => "M.C. Cuffy" 2 => "R.R. Alloway" 3 => "A.R. Shields" 4 => "E.S. Woodle" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/ctr.12335" "Revista" => array:6 [ "tituloSerie" => "Clin Transplant" "fecha" => "2014" "volumen" => "28" "paginaInicial" => "494" "paginaFinal" => "507" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24621089" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0180" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Long-term outcomes of kidney transplantation across a positive complement-dependent cytotoxicity crossmatch" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L.V. Riella" 1 => "K. Safa" 2 => "J. Yagan" 3 => "B. Lee" 4 => "J. Azzi" 5 => "N. Najafian" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01.TP.0000442782.98131.7c" "Revista" => array:6 [ "tituloSerie" => "Transplantation" "fecha" => "2014" "volumen" => "97" "paginaInicial" => "1247" "paginaFinal" => "1252" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24854670" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0275" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "PRA (Panel reactive antibodies) pretrasplante: valor pronóstico en el trasplante renal" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Fernandez" 1 => "A. Alonso" 2 => "C. Calvo" 3 => "L. Beato" 4 => "A. Lopez" 5 => "D. Lorenzo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Nefrología" "fecha" => "2013" "volumen" => "33" "numero" => "Sup2" "paginaInicial" => "156" ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0190" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Banff 2013 Meeting Report: inclusion of C4d-negative antibody-mediated rejection and antibody-associated arterial lesions" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Haas" 1 => "B. Sis" 2 => "L.C. Racusen" 3 => "K. Solez" 4 => "D. Glotz" 5 => "R.B. Colvin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/ajt.12590" "Revista" => array:6 [ "tituloSerie" => "Am J Transplant" "fecha" => "2014" "volumen" => "14" "paginaInicial" => "272" "paginaFinal" => "283" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24472190" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0195" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The revised (2013) Banff classification for antibody-mediated rejection of renal allografts: update, difficulties, and future considerations" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M. Haas" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/ajt.13661" "Revista" => array:6 [ "tituloSerie" => "Am J Transplant" "fecha" => "2016" "volumen" => "16" "paginaInicial" => "1352" "paginaFinal" => "1357" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26696524" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0200" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Kidney transplantation in highly sensitized patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. Jordan" 1 => "J. Choi" 2 => "A. Vo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/bmb/ldv013" "Revista" => array:6 [ "tituloSerie" => "Br Med Bull" "fecha" => "2015" "volumen" => "114" "paginaInicial" => "113" "paginaFinal" => "125" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25935575" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0205" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation and recipients of a first cadaveric transplant" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Wolfe" 1 => "V. Ashby" 2 => "E. Milford" 3 => "A. Ojo" 4 => "R. Ettenger" 5 => "L. Agodoa" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "N Eng J Med" "fecha" => "1999" "volumen" => "341" "paginaInicial" => "1725" "paginaFinal" => "1730" ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0210" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Renal transplantation across the donor specific antibody barrier: graft outcome and cancer risk after desensitization therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C. Yang" 1 => "C. Lee" 2 => "C. Yeh" 3 => "M. Tsai" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "J Formos Med Assoc" "fecha" => "2015" "volumen" => "xx" "paginaInicial" => "1e8" ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0215" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Desensitization before living donor kidney transplantation in highly HLA sensitized patients: a single-center study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:7 [ 0 => "E. De Sousa-Amorin" 1 => "I. Revuelta" 2 => "M. Blasco" 3 => "F. Diekmann" 4 => "J. Cid" 5 => "M. Lozano" 6 => "A. Sanchez Escuredo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.transproceed.2015.09.025" "Revista" => array:6 [ "tituloSerie" => "Transplant Proc" "fecha" => "2015" "volumen" => "47" "paginaInicial" => "2332" "paginaFinal" => "2335" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26518919" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0220" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An integrative approach for the transplantation of high risk sensitized patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Morath" 1 => "J. Beimler" 2 => "G. Opelz" 3 => "J. Ovens" 4 => "S. Scherer" 5 => "J. Schmidt" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/TP.0b013e3181ea3985" "Revista" => array:6 [ "tituloSerie" => "Transplantation" "fecha" => "2010" "volumen" => "90" "paginaInicial" => "645" "paginaFinal" => "653" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20671598" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0225" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Five-year outcomes in living donor kidney transplants with a positive crossmatch" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.L. Bental" 1 => "L. Cornell" 2 => "J. Gloor" 3 => "W. Park" 4 => "M. Gandhi" 5 => "J. Winters" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1600-6143.2012.04291.x" "Revista" => array:6 [ "tituloSerie" => "Am J Transplant" "fecha" => "2013" "volumen" => "13" "paginaInicial" => "76" "paginaFinal" => "85" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23072543" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0230" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Living donor kidney transplantation across positive crossmatch: the University of Illinois at Chicago experience" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Thielke" 1 => "P. West-Thielke" 2 => "H. Herren" 3 => "U. Bareato" 4 => "T. Ommert" 5 => "V. Vidanovic" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/TP.0b013e3181919a16" "Revista" => array:6 [ "tituloSerie" => "Transplantation" "fecha" => "2009" "volumen" => "87" "paginaInicial" => "268" "paginaFinal" => "273" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19155983" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0235" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of a proteosoma inhibitor plus steroids on HLA antibodies in sensitized patients awaiting a renal transplantation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "O. Aubert" 1 => "C. Suberbielle" 2 => "R. Gauth" 3 => "H. Francois" 4 => "E. Obada" 5 => "A. Durrbach" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01.TP.0000438207.42465.40" "Revista" => array:6 [ "tituloSerie" => "Transplantation" "fecha" => "2014" "volumen" => "97" "paginaInicial" => "946" "paginaFinal" => "952" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24759674" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0240" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "[abstract # 151]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prospective, iterative, phased, trial of proteasome inhibitor-based desensitization in highly sensitized renal transplant candidates" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Woodle" 1 => "B. Sadaka" 2 => "R.C. Walsh" 3 => "A. Shields" 4 => "A. Girnita" 5 => "P. Brailey" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1600-6143.2012.04291.x" "Revista" => array:6 [ "tituloSerie" => "Am J Transplant" "fecha" => "2013" "volumen" => "13" "numero" => "Suppl 5" "paginaInicial" => "76" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23072543" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0245" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Outcome after desensitization in HLA or ABO-incompatible kidney transplant recipients: a single center experience" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T. Kauke" 1 => "S. Klimaschewski" 2 => "U. Schoenermarck" 3 => "M. Fischereder" 4 => "A. Dick" 5 => "M. Guba" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1371/journal.pone.0146075" "Revista" => array:3 [ "tituloSerie" => "PLoS ONE" "fecha" => "2016" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25955688" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0250" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Terminal complement inhibition decreases antibody-mediated rejection in sensitized renal transplant recipients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Stegall" 1 => "T. Diwan" 2 => "S. Raghavaiah" 3 => "L. Cornell" 4 => "J. Burns" 5 => "P. Dean" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1600-6143.2011.03757.x" "Revista" => array:7 [ "tituloSerie" => "Am J Transplant" "fecha" => "2011" "volumen" => "11" "paginaInicial" => "2405" "paginaFinal" => "2413" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21942930" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0749806316309884" "estado" => "S300" "issn" => "07498063" ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0255" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rituximab and intravenous immune globulin for desensitization during renal transplantation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Vo" 1 => "M. Lukovsky" 2 => "M. Toyoda" 3 => "J. Wang" 4 => "N. Reinsmoen" 5 => "C. Lai" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "N Eng J Med" "fecha" => "2008" "volumen" => "359" "paginaInicial" => "242" "paginaFinal" => "251" "itemHostRev" => array:3 [ "pii" => "S0892199715000569" "estado" => "S300" "issn" => "08921997" ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0260" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "How can we minimize bleeding complications in ABO-incompatible kidney transplant recipients?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "H. Ohdan" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Transplant Int" "fecha" => "2015" "volumen" => "28" "paginaInicial" => "22" "paginaFinal" => "24" ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0265" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acquired factor XIII deficiency after desensitization as a potential contributor to postoperative bleeding: mare than meets the eye" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "D. Focosi" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Transplant Int" "fecha" => "2015" "volumen" => "28" "paginaInicial" => "246" "paginaFinal" => "247" ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0270" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "ABO-incompatible kidney transplant recipients have a higher bleeding risk after antigen-specific immunoadsorption" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A. De Weerd" 1 => "M. van Agteren" 2 => "F. Leebek" 3 => "J. Ijzermans" 4 => "W. Weimar" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Transplant Int" "fecha" => "2015" "volumen" => "28" "paginaInicial" => "25" "paginaFinal" => "33" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000003700000006/v1_201712030528/S2013251417301876/v1_201712030528/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/20132514/0000003700000006/v1_201712030528/S2013251417301876/v1_201712030528/en/main.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251417301876?idApp=UINPBA000064" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 12 | 5 | 17 |
| 2024 October | 71 | 54 | 125 |
| 2024 September | 92 | 43 | 135 |
| 2024 August | 78 | 74 | 152 |
| 2024 July | 76 | 29 | 105 |
| 2024 June | 84 | 38 | 122 |
| 2024 May | 74 | 55 | 129 |
| 2024 April | 73 | 42 | 115 |
| 2024 March | 52 | 40 | 92 |
| 2024 February | 69 | 57 | 126 |
| 2024 January | 68 | 30 | 98 |
| 2023 December | 51 | 28 | 79 |
| 2023 November | 87 | 51 | 138 |
| 2023 October | 94 | 33 | 127 |
| 2023 September | 74 | 44 | 118 |
| 2023 August | 79 | 33 | 112 |
| 2023 July | 72 | 30 | 102 |
| 2023 June | 80 | 24 | 104 |
| 2023 May | 99 | 34 | 133 |
| 2023 April | 54 | 19 | 73 |
| 2023 March | 65 | 23 | 88 |
| 2023 February | 54 | 18 | 72 |
| 2023 January | 67 | 35 | 102 |
| 2022 December | 91 | 34 | 125 |
| 2022 November | 73 | 29 | 102 |
| 2022 October | 72 | 46 | 118 |
| 2022 September | 76 | 45 | 121 |
| 2022 August | 73 | 59 | 132 |
| 2022 July | 72 | 50 | 122 |
| 2022 June | 81 | 53 | 134 |
| 2022 May | 74 | 57 | 131 |
| 2022 April | 86 | 69 | 155 |
| 2022 March | 57 | 48 | 105 |
| 2022 February | 74 | 48 | 122 |
| 2022 January | 79 | 53 | 132 |
| 2021 December | 106 | 46 | 152 |
| 2021 November | 100 | 40 | 140 |
| 2021 October | 104 | 54 | 158 |
| 2021 September | 91 | 46 | 137 |
| 2021 August | 102 | 40 | 142 |
| 2021 July | 92 | 47 | 139 |
| 2021 June | 54 | 26 | 80 |
| 2021 May | 93 | 58 | 151 |
| 2021 April | 205 | 136 | 341 |
| 2021 March | 88 | 43 | 131 |
| 2021 February | 84 | 32 | 116 |
| 2021 January | 48 | 26 | 74 |
| 2020 December | 57 | 26 | 83 |
| 2020 November | 64 | 32 | 96 |
| 2020 October | 51 | 24 | 75 |
| 2020 September | 50 | 34 | 84 |
| 2020 August | 44 | 14 | 58 |
| 2020 July | 75 | 18 | 93 |
| 2020 June | 78 | 14 | 92 |
| 2020 May | 67 | 20 | 87 |
| 2020 April | 73 | 21 | 94 |
| 2020 March | 77 | 28 | 105 |
| 2020 February | 68 | 21 | 89 |
| 2020 January | 89 | 50 | 139 |
| 2019 December | 67 | 35 | 102 |
| 2019 November | 71 | 24 | 95 |
| 2019 October | 87 | 23 | 110 |
| 2019 September | 102 | 33 | 135 |
| 2019 August | 65 | 30 | 95 |
| 2019 July | 66 | 35 | 101 |
| 2019 June | 377 | 26 | 403 |
| 2019 May | 52 | 12 | 64 |
| 2019 April | 83 | 49 | 132 |
| 2019 March | 66 | 39 | 105 |
| 2019 February | 46 | 23 | 69 |
| 2019 January | 57 | 40 | 97 |
| 2018 December | 178 | 47 | 225 |
| 2018 November | 287 | 21 | 308 |
| 2018 October | 219 | 17 | 236 |
| 2018 September | 147 | 15 | 162 |
| 2018 August | 72 | 20 | 92 |
| 2018 July | 72 | 15 | 87 |
| 2018 June | 85 | 13 | 98 |
| 2018 May | 129 | 18 | 147 |
| 2018 April | 128 | 13 | 141 |
| 2018 March | 66 | 14 | 80 |
| 2018 February | 39 | 7 | 46 |
| 2018 January | 33 | 15 | 48 |
| 2017 December | 48 | 13 | 61 |
| 2017 November | 7 | 1 | 8 |
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