Letter to the Editor
Immediate re-transplantation: An audacious approach to early vascular renal transplant failure
Trasplante exprés: un tratamiento audaz en el fallo técnico precoz del injerto
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"identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "David" "apellidos" => "Rodriguez Santarelli" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Jaime" "apellidos" => "Sanz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Carlos" "apellidos" => "Muñoz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "Pedro" "apellidos" => "Garcia Tabar" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 5 => array:3 [ "nombre" => "Javier" "apellidos" => "Pérez Contreras" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital General de Alicante, Alicante, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Inmunología, Hospital General de Alicante, Alicante, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Urología, Hospital General de Alicante, Alicante, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Trasplante exprés: un tratamiento audaz en el fallo técnico precoz del injerto" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Renal transplantation is the treatment of choice in patients with advanced chronic kidney disease (CKD) as it improves the quality of life and survival of patients.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Vascular complications of renal transplantation represent an important cause of morbidity and mortality, and frequently lead to early graft loss,<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">2</span></a> which is around 5% in the most recent series.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">3</span></a> A 4–10% of patients who start dialysis have a non-functioning kidney graft, and up to 32% of cases require transplantectomy for various reasons.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">4</span></a> The mortality of these patients is greater than those with functional graft or in renal replacement therapy without previous transplantation.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">5</span></a> Current indications for transplantectomy include early graft loss, intolerance syndrome, severe proteinuria, recurrent pyelonephritis, neoplasia, and chronic inflammation syndrome.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">6</span></a> Early vascular complications of transplantation may cause the loss of the graft and the need for transplantectomy.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The performance of express transplant seeks to obtain the benefit of performing an inevitable transplantectomy with the implantation of another graft in the same surgical act. This improves both quality of life and survival of the patient,<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">5</span></a> in addition to ameliorating the psychological problem of early graft loss.</p><p id="par0020" class="elsevierStylePara elsevierViewall">In patients with terminal liver disease, re-transplantation after early graft loss is common otherwise the prognosis is very poor.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">7</span></a> In renal transplantation, such a degree of urgency does not exist due to the availability of other renal replacement techniques,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">1</span></a> thus re-transplantation is not performed early.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The term express used here as the definition made by the Royal Spanish Language Academy “with maximum speed”.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">8</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">We have performed a total of 4 express transplants over a period of 2 years, describing their characteristics and evolution in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">The immediate loss of the graft is included among the indications of transplantectomy and, in this case, it must be performed rapidly, since this almost immediate intervention can prevent foreseeable complications such as graft intolerance, rupture of the graft, infections and formation of antibodies ensuing hyperimmunization of the patient.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">6,9</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Performance of express transplant has several advantages: it avoids the morbimortality of the transplantectomy as a necessary but isolated act, since in the same act another transplant is carried out, immunosuppression is maintained which prevents the formation of antibodies and the hyperimmunization of the patient and finally it avoids the negative psychological impact of graft loss and preserves the confidence of patient on the actual medical care.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Prior to the procedure, it is important to rule out other causes of early graft loss, such as hyperacute rejection,<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">10</span></a> or problems with hypercoagulability<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">9</span></a> since both situations would contraindicate express transplantation. In our cases, the immunological study carried out after graft loss, the histological absence of acute rejection and the lack of history of thrombotic events in the recipients, reasonably ruled out these causes.</p><p id="par0050" class="elsevierStylePara elsevierViewall">This type of transplantation requires a potent immunosuppression together with strict immunological study of the donor and recipient to reduce compatibility requirements given the time constraint to perform the transplant within the immediate postoperative period. The immunological study should include the detection of specific donor antibodies that could have been generated with the first transplantation and its characterization, since the presence of an infarcted graft stimulates the production of these antibodies.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">10</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">All our recipients of express transplant received immunosuppression with thymoglobulin. Phelan et al.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">9</span></a> have reported a series cases with similar characteristics as ours, there were 9 cases collected over a period of 20 years. These patients had early graft loss due to vascular complications and were re-implanted in the subsequent days. Our series include cases in which transplantation was completed in a much shorter period of time, which provides more homogeneity than the Phelan series. In Phelan series the transplantectomy was not performed in the same surgical procedure as the re-transplantation, which undermines the effectiveness of the strategy. In addition, the aforementioned series differs from ours in that the immunosuppression used in the second transplant only included induction with antibodies in 2 out of the 9 cases. This resulted in an acute rejection of 30% in the total serie and in almost half (42.8%) of the patients without induction; thus the cause of graft loss. This experience reaffirms the strategy of administration a powerful immunosuppression to our patients, with a 0% rate of acute rejection and graft loss due to this cause.</p><p id="par0060" class="elsevierStylePara elsevierViewall">The strategy of express transplantation depends on the availability of renal grafts in sufficient quantity and frequency in order to perform the re-transplantation within the immediate postoperative period. These conditions are fulfilled in our environment.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">11</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Our experience has been positive and lead us to the individualized but systematic evaluation of all recipients with early graft failure secondary to vascular complications as potential candidates to undergo express transplantation</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Franco A, Rodriguez Santarelli D, Sanz J, Muñoz C, Garcia Tabar P, Pérez Contreras J. Trasplante exprés: un tratamiento audaz en el fallo técnico precoz del injerto. Nefrologia. 2017;37:655–657.</p>" ] ] "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">P Cr: plasma creatinine; PD: peritoneal dialysis; CKD: chronic kidney disease; FSG: focal and segmental glomerulosclerosis; HD: hemodialysis; MFM: mycophenolate mofetil; NAE: nephroangiosclerosis; ND: diabetic nephropathy; TIN: tubulointerstitial nephritis; P: prednisone; Pre-D: predialysis; T: thrombosis; TG: thymoglobulin; RRT: renal replacement therapy; Tx: transplantation.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" 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">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></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">Recipient gender \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">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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">65 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">64 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">33 \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">Type of RRT pre Tx \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">PD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pre-D \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pre-D \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">Cause of CKD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NAE \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">TIN \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">FSG \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ND \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">1st donor \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cadaveric \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cadaveric \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Alive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cadaveric \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">2nd donor \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cadaveric \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cadaveric \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cadaveric \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cadaveric \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">Cause of graft failure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Vein T. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Vein T. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Arterial T. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Arterial T. \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">Time between transplants (h) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">336 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">62 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">44.5 \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">Time Cold ischemia 2nd graft (h) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">14 \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">Immunosuppression \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">TG, MFM, FK and P \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">TG, MFM, FK and P \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">TG, MFM, FK and P \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">TG, MFM, FK and P \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">Acute rejection \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><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">P Cr at discharge \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.3<span class="elsevierStyleHsp" style=""></span>mg/dl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.04<span class="elsevierStyleHsp" style=""></span>mg/dl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.62<span class="elsevierStyleHsp" style=""></span>mg/dl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.6<span class="elsevierStyleHsp" style=""></span>mg/dl \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">P Cr at the end of follow-up (19months) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.15<span class="elsevierStyleHsp" style=""></span>mg/dl (19 months) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.15<span class="elsevierStyleHsp" style=""></span>mg/dl (15 months) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.43<span class="elsevierStyleHsp" style=""></span>mg/dl (13 months) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.2<span class="elsevierStyleHsp" style=""></span>mg/dl (12 months) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1609192.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Summary of case description of transplant “express”.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:11 [ 0 => array:3 [ "identificador" => "bib0060" "etiqueta" => "1" "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.A. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 7 | 7 | 14 |
| 2024 October | 45 | 42 | 87 |
| 2024 September | 44 | 28 | 72 |
| 2024 August | 61 | 62 | 123 |
| 2024 July | 43 | 30 | 73 |
| 2024 June | 48 | 26 | 74 |
| 2024 May | 57 | 28 | 85 |
| 2024 April | 50 | 33 | 83 |
| 2024 March | 38 | 25 | 63 |
| 2024 February | 48 | 38 | 86 |
| 2024 January | 25 | 22 | 47 |
| 2023 December | 37 | 28 | 65 |
| 2023 November | 59 | 38 | 97 |
| 2023 October | 44 | 34 | 78 |
| 2023 September | 28 | 35 | 63 |
| 2023 August | 33 | 37 | 70 |
| 2023 July | 31 | 28 | 59 |
| 2023 June | 65 | 18 | 83 |
| 2023 May | 71 | 29 | 100 |
| 2023 April | 63 | 17 | 80 |
| 2023 March | 91 | 18 | 109 |
| 2023 February | 54 | 23 | 77 |
| 2023 January | 34 | 28 | 62 |
| 2022 December | 46 | 36 | 82 |
| 2022 November | 57 | 22 | 79 |
| 2022 October | 48 | 36 | 84 |
| 2022 September | 48 | 30 | 78 |
| 2022 August | 47 | 46 | 93 |
| 2022 July | 40 | 52 | 92 |
| 2022 June | 32 | 33 | 65 |
| 2022 May | 45 | 24 | 69 |
| 2022 April | 42 | 49 | 91 |
| 2022 March | 28 | 34 | 62 |
| 2022 February | 54 | 45 | 99 |
| 2022 January | 47 | 30 | 77 |
| 2021 December | 41 | 41 | 82 |
| 2021 November | 44 | 48 | 92 |
| 2021 October | 53 | 45 | 98 |
| 2021 September | 26 | 29 | 55 |
| 2021 August | 30 | 42 | 72 |
| 2021 July | 35 | 36 | 71 |
| 2021 June | 22 | 29 | 51 |
| 2021 May | 43 | 43 | 86 |
| 2021 April | 70 | 85 | 155 |
| 2021 March | 57 | 51 | 108 |
| 2021 February | 48 | 36 | 84 |
| 2021 January | 36 | 18 | 54 |
| 2020 December | 37 | 18 | 55 |
| 2020 November | 31 | 16 | 47 |
| 2020 October | 27 | 18 | 45 |
| 2020 September | 34 | 10 | 44 |
| 2020 August | 44 | 11 | 55 |
| 2020 July | 41 | 16 | 57 |
| 2020 June | 22 | 16 | 38 |
| 2020 May | 28 | 11 | 39 |
| 2020 April | 54 | 23 | 77 |
| 2020 March | 38 | 6 | 44 |
| 2020 February | 45 | 22 | 67 |
| 2020 January | 53 | 23 | 76 |
| 2019 December | 46 | 26 | 72 |
| 2019 November | 50 | 29 | 79 |
| 2019 October | 29 | 15 | 44 |
| 2019 September | 39 | 16 | 55 |
| 2019 August | 34 | 17 | 51 |
| 2019 July | 38 | 23 | 61 |
| 2019 June | 46 | 20 | 66 |
| 2019 May | 36 | 23 | 59 |
| 2019 April | 46 | 38 | 84 |
| 2019 March | 44 | 25 | 69 |
| 2019 February | 32 | 19 | 51 |
| 2019 January | 31 | 23 | 54 |
| 2018 December | 89 | 42 | 131 |
| 2018 November | 136 | 25 | 161 |
| 2018 October | 87 | 10 | 97 |
| 2018 September | 62 | 24 | 86 |
| 2018 August | 41 | 12 | 53 |
| 2018 July | 41 | 14 | 55 |
| 2018 June | 36 | 10 | 46 |
| 2018 May | 35 | 11 | 46 |
| 2018 April | 37 | 10 | 47 |
| 2018 March | 36 | 13 | 49 |
| 2018 February | 26 | 1 | 27 |
| 2018 January | 25 | 8 | 33 |
| 2017 December | 43 | 9 | 52 |
| 2017 November | 8 | 1 | 9 |
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