Letter to the Editor
Intravenous immunoglobulins: A therapeutic alternative to consider in kidney transplant patients with COVID-19
Inmunoglobulinas por vía intravenosa: una alternativa terapéutica a tener en cuenta en el paciente trasplantado renal con COVID-19
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Mathew" "autores" => array:7 [ 0 => array:2 [ "nombre" => "Kam Sing" "apellidos" => "Ho" ] 1 => array:2 [ "nombre" => "Bharat" "apellidos" => "Narasimhan" ] 2 => array:2 [ "nombre" => "Aravinth" "apellidos" => "Kumar" ] 3 => array:2 [ "nombre" => "Erin" "apellidos" => "Flynn" ] 4 => array:2 [ "nombre" => "James" "apellidos" => "Salonia" ] 5 => array:2 [ "nombre" => "Karim" "apellidos" => "El-Hachem" ] 6 => array:2 [ "nombre" => "Joseph P." "apellidos" => "Mathew" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251421000183?idApp=UINPBA000064" "url" => "/20132514/0000004100000002/v1_202106220601/S2013251421000183/v1_202106220601/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Intravenous immunoglobulins: A therapeutic alternative to consider in kidney transplant patients with COVID-19" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "220" "paginaFinal" => "222" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Abraham David Sánchez Cadena, Martín Negreira Caamaño, Raúl Pérez Serrano, María Lourdes Porras Leal" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Abraham David" "apellidos" => "Sánchez Cadena" "email" => array:1 [ 0 => "asancad@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Martín" "apellidos" => "Negreira Caamaño" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Raúl" "apellidos" => "Pérez Serrano" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "María Lourdes" "apellidos" => "Porras Leal" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Farmacia, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Cardiología, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital General Universitario de Ciudad Real, Ciudad Real, 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" => "Inmunoglobulinas por vía intravenosa: una alternativa terapéutica a tener en cuenta en el paciente trasplantado renal con COVID-19" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1145 "Ancho" => 1500 "Tamanyo" => 151520 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Chest X-ray showing the patient's radiological course during his first admission (A–B) and his second admission (C–D).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Infection with the coronavirus SARS-CoV-2, causing COVID-19, originated in Wuhan, China, in December 2019.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> This infection quickly propagated around the world, affecting numerous countries, and was declared a pandemic by the World Health Organization on 11 March 2020.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Subgroups at risk of developing severe forms of the disease have been identified, including kidney transplant patients, who have a greater incidence of infection and admission, as well as a greater need for admission in intensive care units.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> Immunosuppressant treatment is one of the reasons for this population's vulnerability.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The management of immunosuppressant treatment in a context of SARS-CoV-2 infection is unclear.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3,4</span></a> In addition, the safety and interaction profile of certain drugs used to treat the infection limits their use. Within this treatment group, intravenous non-specific human immunoglobulins (IV Ig) may have a good profile, making them an interesting alternative treatment.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">We report the case of a 72-year-old man with hypertension and dyslipidaemia who underwent kidney transplantation in 2012. He was on immunosuppressant treatment with tacrolimus and everolimus and had a baseline creatinine level of 1.43<span class="elsevierStyleHsp" style=""></span>mg/dl. The patient visited the emergency department where he reported experiencing general malaise and headache for the previous three days. He had normal blood pressure levels, an axillary temperature of 37<span class="elsevierStyleHsp" style=""></span>°C and an oxygen saturation (O2 sat) of 92% breathing room air. A chest X-ray showed bilateral pulmonary interstitial infiltrates (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). Laboratory testing revealed kidney failure (creatinine 2.52<span class="elsevierStyleHsp" style=""></span>mg/dl and urea 77<span class="elsevierStyleHsp" style=""></span>mg/dl) and higher levels of tacrolimus (15.1<span class="elsevierStyleHsp" style=""></span>ng/ml) compared to his most recent visit. Polymerase chain reaction (PCR) testing of the patient's nasopharyngeal discharge was positive for SARS-CoV-2. A decision was made to admit him and start treatment with hydroxychloroquine, azithromycin and lopinavir/ritonavir along with ceftizadime and glucocorticoids (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). The immunosuppressant treatment the patient was on was suspended.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Following five days of admission, during which the patient responded favourably (laboratory testing showed that his inflammatory parameters decreased and his kidney function returned to normal), he presented an increase in tacrolimus levels (29.31<span class="elsevierStyleHsp" style=""></span>ng/ml), which returned to normal after four days. Another X-ray was taken and ruled out progression (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). A decision was made to discharge him from hospital and restart his prior immunosuppressant treatment at his usual doses.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Seven days later, the patient returned to the emergency department and reported experiencing fever in recent days, with gradually increasing dyspnoea accompanied by micturition syndrome. A new chest X-ray showed worsening compared to the patient's prior chest X-ray (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C). Laboratory testing showed leukocytosis (16,400/μl) with lymphopenia (600/μl) and elevated acute-phase reactants (C-reactive protein [CRP] 7.6<span class="elsevierStyleHsp" style=""></span>mg/dl, D-dimer 886<span class="elsevierStyleHsp" style=""></span>μg/l and procalcitonin 3.88<span class="elsevierStyleHsp" style=""></span>ng/ml). Treatment was started with IV Ig plus linezolid and meropenem. The patient was admitted (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>) and his prior immunosuppressant treatment was resuspended.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Five days of treatment with IV Ig were completed. The patient did not present any adverse reactions and did show marked clinical improvement; his dyspnoea disappeared and he showed improvement on X-ray (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>D). This allowed him to be discharged from hospital early, on day six.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The case reported reflects the complexity of treating SARS-CoV-2 infection in a kidney transplant patient, as the patient's treatment was found to be limited by drug interactions. In this case, the interaction between tacrolimus and lopinavir/ritonavir was assumed to be the main reason for the patient's elevated tacrolimus levels, though the concomitant decline in kidney function may have contributed.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> Management of immunosuppressant treatment in transplant patients with COVID-19 is debated. Although some published reports are available, the repercussions of maintaining usual immunosuppressant doses in the context of this infection are unknown.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3,4,7</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Moreover, SARS-CoV-2 infection still lacks effective treatment. The limited benefits of lopinavir/ritonavir seen in recent studies cast doubt on their usefulness, especially in patients who are more susceptible to their toxic effects.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Another group of drugs that have been gaining reputation in the control of severe forms of infection are biologic drugs. However, their use is restricted in previously immunosuppressed patients. In this regard, treatment with IV Ig is gaining importance and represents an appealing option due to their safety profile and their potential efficacy achieved by means of modulation of inflammatory response. While evidence supporting their use is limited, recently published cases point to a possible benefit in severe forms of COVID-19.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> Their use has also been associated with a good clinical outcome in kidney transplant patients.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> The case reported constitutes the first in Spain supporting the use of IV Ig in kidney transplant patients with severe forms of COVID-19.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Please cite this article as: Sánchez Cadena AD, Negreira Caamaño M, Pérez Serrano R, Porras Leal ML. Inmunoglobulinas por vía intravenosa: una alternativa terapéutica a tener en cuenta en el paciente trasplantado renal con COVID-19. Nefrologia. 2021;41:220–222.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1145 "Ancho" => 1500 "Tamanyo" => 151520 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Chest X-ray showing the patient's radiological course during his first admission (A–B) and his second admission (C–D).</p>" ] ] 1 => 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="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Treatment \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Drug \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Dose \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Route of administration \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Dosing regimen \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Start (day since admission) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Duration (days) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Targeted COVID-19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hydroxychloroquine<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="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">400<span class="elsevierStyleHsp" style=""></span>mg/200<span class="elsevierStyleHsp" style=""></span>mg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Oral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Initial loading dose.Every 12<span class="elsevierStyleHsp" style=""></span>h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lopinavir/ritonavir<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="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">400<span class="elsevierStyleHsp" style=""></span>mg/100<span class="elsevierStyleHsp" style=""></span>mg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Oral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Every 12<span class="elsevierStyleHsp" style=""></span>h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Azithromycin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">500<span class="elsevierStyleHsp" style=""></span>mg/250<span class="elsevierStyleHsp" style=""></span>mg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Oral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Initial loading dose.Every 24<span class="elsevierStyleHsp" style=""></span>h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Immunoglobulins<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="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.4<span class="elsevierStyleHsp" style=""></span>g/kg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Intravenous \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Every 24<span class="elsevierStyleHsp" style=""></span>h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="7" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Support treatment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ceftazidime \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2<span class="elsevierStyleHsp" style=""></span>g \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Intravenous \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Every 12<span class="elsevierStyleHsp" style=""></span>h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Methylprednisolone<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="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">250<span class="elsevierStyleHsp" style=""></span>mg, 80<span class="elsevierStyleHsp" style=""></span>mg, 40<span class="elsevierStyleHsp" style=""></span>mg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Intravenous \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Single initial dose with subsequent down-titration regimenEvery 24<span class="elsevierStyleHsp" style=""></span>h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Meropenem<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="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2<span class="elsevierStyleHsp" style=""></span>g \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Intravenous \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Every 12<span class="elsevierStyleHsp" style=""></span>h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Linezolid<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="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">600<span class="elsevierStyleHsp" style=""></span>mg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Intravenous \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Every 12<span class="elsevierStyleHsp" style=""></span>h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2628818.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">First admission.</p>" ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Second admission.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Summary table of the treatments administered during the patient's first and second admissions.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Phase-adjusted estimation of the number of coronavirus disease 2019 cases in Wuhan, China" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "H. Wang" 1 => "Z. Wang" 2 => "Y. Dong" 3 => "R. Chang" 4 => "C. Xu" 5 => "X. Yu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/s41421-020-0148-0" "Revista" => array:3 [ "tituloSerie" => "Cell Discov" "fecha" => "2020" "volumen" => "6" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Situación de la infección por SARS-CoV-2 en pacientes en tratamiento renal sustitutivo Informe del Registro COVID-19 de la Sociedad Española de Nefrología (SEN)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.E. Sánchez-Álvarez" 1 => "M. Pérez Fontán" 2 => "C. Jiménez Martín" 3 => "M. Blasco Pelícano" 4 => "C.J. Cabezas Reina" 5 => "Á.M. Sevillano Prieto" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.nefro.2020.04.002" "Revista" => array:3 [ "tituloSerie" => "Nefrología" "fecha" => "2020" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11217655" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Recommendations on management of the SARS-CoV-2 coronavirus pandemic (COVID-19) in kidney transplant patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "V. López" 1 => "T. Vázquez" 2 => "J. Alonso-Titos" 3 => "M. Cabello" 4 => "A. Alonso" 5 => "I. Beneyto" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.nefroe.2020.03.017" "Revista" => array:3 [ "tituloSerie" => "Nefrologia" "fecha" => "2020" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11217655" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "COVID-19 infection in kidney transplant recipients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "D. Banerjee" 1 => "J. Popoola" 2 => "S. Shah" 3 => "I.C. Ster" 4 => "V. Quan" 5 => "M. Phanish" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.kint.2020.03.018" "Revista" => array:2 [ "tituloSerie" => "Kidney Int" "fecha" => "2020" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Guideline on core SmPC for human normal immunoglobulin for intravenous administration (IVIg)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Committee for Medicinal Products for Human Use (CHMP)" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:2 [ "fecha" => "2007" "editorial" => "Eur Med Agency" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0080" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tacrolimus and lopinavir/ritonavir interaction in liver transplantation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "K.S. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 5 | 11 | 16 |
| 2024 October | 69 | 50 | 119 |
| 2024 September | 70 | 45 | 115 |
| 2024 August | 105 | 64 | 169 |
| 2024 July | 64 | 46 | 110 |
| 2024 June | 73 | 44 | 117 |
| 2024 May | 82 | 36 | 118 |
| 2024 April | 94 | 44 | 138 |
| 2024 March | 60 | 28 | 88 |
| 2024 February | 55 | 39 | 94 |
| 2024 January | 48 | 31 | 79 |
| 2023 December | 29 | 36 | 65 |
| 2023 November | 78 | 49 | 127 |
| 2023 October | 113 | 50 | 163 |
| 2023 September | 60 | 36 | 96 |
| 2023 August | 63 | 34 | 97 |
| 2023 July | 79 | 34 | 113 |
| 2023 June | 68 | 23 | 91 |
| 2023 May | 64 | 28 | 92 |
| 2023 April | 45 | 34 | 79 |
| 2023 March | 83 | 28 | 111 |
| 2023 February | 69 | 26 | 95 |
| 2023 January | 58 | 34 | 92 |
| 2022 December | 88 | 35 | 123 |
| 2022 November | 74 | 42 | 116 |
| 2022 October | 101 | 77 | 178 |
| 2022 September | 56 | 50 | 106 |
| 2022 August | 62 | 49 | 111 |
| 2022 July | 67 | 58 | 125 |
| 2022 June | 57 | 47 | 104 |
| 2022 May | 64 | 27 | 91 |
| 2022 April | 67 | 42 | 109 |
| 2022 March | 68 | 57 | 125 |
| 2022 February | 60 | 41 | 101 |
| 2022 January | 88 | 69 | 157 |
| 2021 December | 61 | 59 | 120 |
| 2021 November | 56 | 37 | 93 |
| 2021 October | 59 | 62 | 121 |
| 2021 September | 39 | 61 | 100 |
| 2021 August | 47 | 61 | 108 |
| 2021 July | 42 | 60 | 102 |
| 2021 June | 39 | 20 | 59 |
| 2021 May | 44 | 38 | 82 |
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