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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction and objectives</span><p id="par0005" class="elsevierStylePara elsevierViewall">There is currently no doubt that kidney transplantation is the best treatment we can offer to a child with chronic kidney failure&#46; A transplant&#44; with a good graft function&#44; allows healthcare workers to correct to a large extent the metabolic alterations secondary to the disease&#44; correct anemia&#44; improve appetite and&#44; with it&#44; nutritional status&#44; improve activity&#44; growth&#44; social relationships&#8230; in short&#44; improve the child&#39;s quality of life&#46; All this necessarily entails lifelong immunosuppressive treatment&#44; with periodic medical checks&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">But the life expectancy of a child is long&#44; longer than the expected survival time of the graft&#44; so the individual will need several grafts over their lifetime&#44; with periods of organ malfunction that will require returning to multiple treatments in addition to the usual treatment with immunosuppressants&#44; more frequent visits and medical checks and&#44; most likely&#44; new periods of treatment by dialysis&#46; That is&#44; with a kidney transplant we do not &#8220;cure&#8221; a pediatric patient with kidney failure&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">What happens to these patients next&#44; when we transfer them to adult units upon reaching the age of adulthood&#63; What is their life expectancy&#63; What problems have they encountered throughout their lives&#63; Do they achieve an &#8220;acceptable&#8221; quality of life&#63;</p><p id="par0020" class="elsevierStylePara elsevierViewall">There are few studies on these issues&#44; probably because it is difficult to conduct multiple follow-ups across different units&#44; different hospitals&#44; and different cities over many years&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Currently&#44; the great development of computer science and communication has facilitated long-term monitoring of this population&#44; allowing us to better understand the lives of these children and adults&#44; and thus&#44; perhaps&#44; we can consider new challenges to improve their quality of life&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">With this idea&#44; 40 years since the beginning of the kidney transplant program in the pediatric unit of the hospital where we work&#44; we have tried to synthesize the lives of our patients&#44; reflecting&#44; more than their clinical-analytical data&#44; their development and their achievements&#44; in order to know what we are offering when we transplant these patients and what we can do to improve their futures&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><p id="par0035" class="elsevierStylePara elsevierViewall">Retrospectively&#44; through medical records - initially on paper&#44; later in computer databases- and prospectively&#44; through outpatient medical visits&#44; through emails or postal mail and telephone calls&#44; we have monitored the 345 pediatric kidney transplants conducted by the Pediatric Nephrology unit of the Virgen del Roc&#237;o University Hospitals&#44; in Seville&#46; The study covered a period of time of 40 years since the beginning of the transplant program in our unit&#46; Patients were transferred to the adult units closest to their places of residence at the age of 18&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Through the medical records we have collected the deaths and the current clinical situation of the patients to study the survival of both the graft and the patient&#46; Through conversations with them&#44; emails and phone calls&#44; we have asked them&#44; including those of adult age and transferred to adult services&#44; the questions that are included in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> to learn some aspects of their quality of life over time&#44; which was what most interested us&#44; also encouraging them to tell us what they wanted about themselves and if they were satisfied&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">We defined comorbidity as the involvement of at least one organ other than the kidney&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The first pediatric kidney transplant in our hospital was performed on June 1&#44; 1979&#44; and we have collected in this work all transplants performed since then until June 1&#44; 2019&#44; 40 years later&#44; with a minimum follow-up time of one year in all patients&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Graft and recipient survival data have been analyzed with the IBM SPSS Statistics 20&#46;0 statistical program&#44; estimating patient and graft survival using the Kaplan-Meier method&#46; We consider patient survival the period elapsed from the first graft until death&#44; regardless of whether they have been transplanted on more than one occasion&#44; since what we want to highlight fundamentally in this work is the future change in quality of life of these patients&#44; from when their kidney function declines to the point of requiring a transplant&#44; currently considered the ideal treatment&#46; The survival of the grafts&#44; measured from the time of transplantation until restarting dialysis or needing a new graft&#44; is calculated from the total of those implanted in each period without taking into account whether it was the first or a retransplant&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0060" class="elsevierStylePara elsevierViewall">In these 40 years of activity in child kidney transplantation&#44; 345 transplants were performed in 287 patients under 18 years of age&#44; with ages ranging from 1&#46;5 years in the case of the youngest patient to 17&#46;8 years for the oldest&#46; The smallest weighed 8&#46;9&#160;kg&#46; The main characteristics of the population studied are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Today we have lost track of 17 of these 287 patients&#44; so we do not know their current situation&#46; But we do know that of the remaining 270&#44; 45 have died&#44; that is&#44; the mortality rate has been 16&#46;66&#37; of patients in these 40 years&#46; The youngest died at the age of 1&#46;5 years&#44; and the oldest is 37&#46;5 years old&#46; The median age at death was 19 years&#44; with a median time since the first transplant of 9 years &#40;range from 48&#160;hours to 25 years&#41;&#46; Nine of these 45 patients had already received a second graft&#44; 3 of them after being transferred to adult services&#46; Fifteen died with a functioning graft&#44; and the remaining 30 were back on dialysis due to graft failure&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">The causes of death&#44; of which we know 29&#44; are listed in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#59; we highlight that the leading cause is infection&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">We analyzed the survival of grafts and recipients by differentiating two groups&#58; those who received grafts between 1979 and 1996 inclusive&#44; and those who received them from 1997 to 2019&#46; The first group &#40;93 grafts&#44; 77 patients&#41; received as immunosuppressive treatment cyclosporine &#40;with controls of plasma levels with much variability&#41;&#44; azathioprine and prednisone&#59; the second group &#40;252 grafts&#44; 210 patients&#41; received treatment with calcineurins inhibitors &#40;29 with cyclosporine with better controlled levels&#44; the remaining 223 with tacrolimus&#41;&#44; mycophenolate mofetil&#44; and prednisone&#46; Survival&#44; both of the grafts and of the patients&#44; has improved markedly in the second period&#44; as can be seen in <a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1 and 2</a>&#46; Patients transplanted in the period from 1979 to 1996 had a survival of 83&#37;&#44; 76&#37; and 65&#37;&#44; respectively&#44; at 10&#44; 20&#44; and 25 years after the intervention&#46; Survival of transplants in the period 1997&#8211;2019 was 94&#37; and 82&#37;&#44; respectively&#44; at 10 and 20 years &#40;<span class="elsevierStyleItalic">P</span>&#160;&#60;&#160;&#46;01&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">Graft survival in the period from 1979 to 1996 at 10 and 20 years of follow-up was 39&#37; and 18&#37;&#44; respectively&#44; improving in the second period to 68&#37; at 10 years and 34&#37; at 20 years&#46; The median estimated in the first period was 7&#46;36 years&#44; compared to 15&#46;156 years in the second period &#40;<span class="elsevierStyleItalic">P</span>&#160;&#60;&#160;&#46;0001&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Living donor transplants began in our unit in 2005&#44; achieving a total of 43 transplants in 2019&#46; Survival of these grafts&#44; all early transplants&#44; was 89&#37; at 10 years&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Despite this&#44; 48 &#40;16&#44;7&#37;&#41; of the 287 patients had received a second graft before reaching the age of 18 years&#44; 8 of these 48 had been transplanted for the third time and two of these 8 had already received a fourth transplant before reaching adulthood&#44; thus before being transferred to adult nephrology services&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">During the follow-up time in adult services 40 more patients received a second kidney transplant&#44; 14 a third and 2 a fourth and&#44; subsequently&#44; one patient received a fifth graft&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Today&#44; the oldest of these patients would now be 54 years old&#46; The average age of the 225 patients that we know and are currently alive is 21&#46;2 years&#44; ranging from 4 years old to 50 years&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">As of June 1&#44; 2020&#44; 150 patients were already adults &#40;&#62;18 years&#41; and 114 of them were &#8805;25 years of age&#44; excluding the deceased and those lost to follow-up&#46; On the other hand&#44; 75 patients had not yet reached the age of 18&#46; One hundred and eighty-two had a working graft &#40;81&#37;&#41;&#44; with the remaining 43 &#40;19&#37;&#41; undergoing chronic dialysis treatment&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Eighty two out of the 150 adult patients responded to our survey&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Of these&#44; 31 &#40;38&#37;&#41; are married or with a stable partner&#44; only 10 have children &#40;two have two children&#44; the rest one&#41;&#59; 32 of them &#40;39&#37;&#41; are living independently from their families&#44; with or without a partner&#46; Some &#40;16&#37;&#41; highlighted their short stature &#40;well below that expected by family inheritance&#58; &#60;&#60; P3&#41;&#44; and 4 of them mentioned their obesity&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">In terms of education&#44; only 13 &#40;16&#37;&#41; have higher education and 23 &#40;28&#37;&#41; have a secondary or vocational education&#46; The rest &#40;56&#37;&#41; had studied&#44; at most&#44; until the first stage of secondary education&#46; A 35&#37; &#40;n&#160;&#61;&#160;29&#41; have a job&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Twenty-six percent said that they were happy&#47;satisfied with their quality of life&#59; in their opinion&#44; their lives are similar to those of their friends without chronic disease&#46; Only three reported notable limitations in their lives&#44; although at least 30&#37; of them have other comorbidities or pathologies associated with their kidneys&#44; particularly liver pathologies &#40;10 patients&#44; of which 4 have subsequently undergone liver transplants&#41;&#44; malignancies &#40;13&#41;&#44; severe bone disorders &#40;8 patients&#44; 4 of them with hip and&#47;or knee prostheses&#41;&#44; diabetes &#40;5&#41;&#44; mental disorders &#40;3&#41;&#44; deafness &#40;3&#41;&#44; cataracts &#40;2&#41;&#44; and organic involvement secondary to severe arterial hypertension &#40;2&#41;&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Only 9&#37; exercised regularly&#44; and 5 of the 82 respondents &#40;6&#37;&#41; reported drug addictions&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">With the exception of two patients&#44; all reported that they were happy to learn that we were interested in their lives&#44; their achievements and their expectations&#44; and wanted to share their stories and their difficulties&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">All but one claimed to have good memories of their time in the Pediatric Nephrology unit despite multiple admissions&#44; analytical extractions&#44; treatments&#44; and tests&#46; We include a sample of short selections from their answers at the end of this work&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0145" class="elsevierStylePara elsevierViewall">In our patients&#44; as in other pediatric samples&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> the most frequent etiology that leads a child to require a kidney transplant is congenital structural abnormalities of the urinary system&#44; followed by hereditary diseases&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Life expectancy is the average number of years that a person of a certain age would expect to continue living if the currently observed pattern of mortality by age &#40;mortality rates by age&#41; were maintained&#46; In Spain&#44; between 1999 and 2019 the life expectancy at birth of men has gone from 75&#46;4 to 80&#46;9 years and that of women from 82&#46;3 to 86&#46;2 years&#44; according to the basic demographic indicators published by Spain&#8217;s National Institute of Statistics &#40;June 2020&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">Given the age at transplantation of all the patients collected in this work under 18 years&#44; their average post-transplant life expectancy&#44; according to the European registry&#44; would be 63 years&#44; as shown in <a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#44;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> or according to the life expectancy of the general population by age groups&#44; in Spain&#44; as shown in <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> &#40;somewhat lower in the years we transplanted our first patients&#41;&#46; It is still too early to know how many of our patients will reach those ages&#44; given that the oldest at the time of this study could not have been older than 54 years at the time&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0160" class="elsevierStylePara elsevierViewall">Considering that the mortality rate for the Spanish population in 1996 was 8&#46;75 per thousand inhabitants&#44; it was similar in 2019&#58; 8&#46;83 per thousand inhabitants&#46; In our autonomous community&#44; Andalusia&#44; the mortality rate for the total population in 1996 was somewhat lower&#44; at 8&#46;18 per thousand&#44; remaining at 2019 at 8&#46;35 per thousand&#46; If we examine mortality in Andalusia in the same years for the age group between 1 and 39 years&#44; in 1996 it was 5&#46;76 per thousand inhabitants&#44; having decreased in 2019 to 2&#46;09 per thousand&#46; It is difficult to compare this mortality rate with that obtained in our patients&#44; given the different ages and annual variations&#44; but the average rate obtained roughly over these years&#44; is 4&#46;16 annual deaths per thousand&#46; Although as seen in the survival graphs&#44; both the grafts and the patients have improved survival in the last 20 years&#44; with a higher mortality rate in the period from 1979 to 1996 for the same post-transplant time period &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">This patient survival is similar to those obtained in other pediatric patient samples in the literature<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#8211;6</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>&#41; in the same time period&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0170" class="elsevierStylePara elsevierViewall">To compare the survival of the grafts with those obtained in other samples<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#8211;7</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a>&#41; it must be considered that those collected by other authors are calculated only for first grafts&#44; whose overall survival is often higher than in retransplants&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a> We have not made that distinction&#44; so the average survival of the grafts calculated in this work may be lower due to retransplantation&#46;</p><elsevierMultimedia ident="tbl0030"></elsevierMultimedia><p id="par0175" class="elsevierStylePara elsevierViewall">Of course&#44; we also note that although there has been less follow-up time since the start of living donor transplants in our unit in 2005&#44; and fewer transplants performed&#44; living donor transplants appear to have better survival compared to that of cadaveric donor transplantation&#44; as reported in other pediatric samples&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">It is worth noting the number of patients with onset of kidney failure at an early age who have already received more than one graft when reaching adulthood&#44; which means that many of these patients are sensitized with a high percentage of antibodies&#46; This - coupled with the loss of preference in the waiting lists when they reach adulthood- makes a new transplant more difficult and forces them to remain in dialysis for a long time during early adulthood&#44; with disruptive impacts on their lives&#44; as we see in some of the patient comments&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">The educational level of the adult population<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> &#40;aged 25&#8211;64&#41; is an indicator related to the development and employment levels of current and future society&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">In Spain&#44; in the year 2019&#44; 41&#46;7&#37; of men and 35&#46;7&#37; of women &#40;aged 25&#8211;64&#41; had a 0&#8211;2 level of education corresponding to preschool&#44; primary and first stage of secondary education&#44; with the percentages of the population being lower at higher educational levels&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">By age group&#44; in the population aged 25&#8211;34&#44; 40&#46;6&#37; of men and 52&#46;4&#37; of women have a level of training corresponding to higher education and doctorate &#40;levels 5&#8211;8&#41;&#46; For the same age group&#44; the percentages with a level of training lower than the second stage of secondary education&#44; that is&#44; level 0&#8211;2&#44; are 35&#46;5&#37; in men and 24&#46;8&#37; in women&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">Only 16&#37; of patients in this series have higher education &#40;level 5&#8211;8&#41; and 28&#37; have intermediate or vocational training &#40;level 3&#8211;4&#41;&#59; the remaining 56&#37; have training equivalent to levels 0&#8211;2&#46; Some 42&#37; dropped out of school early&#46; There were no significant differences in the level of education in relation to sex&#46; This differs with some of the few studies that collect this data in the literature&#44; such as Mekahli et al&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> and Rosenkranz et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> which find a high percentage of patients with complete studies and professional studies although with a lower employment rate than the general population&#44; although they are limited to a small group of patients chosen to participate in another study&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">In the year 2020&#44; in Spain&#44; school dropouts&#44; despite having been reduced compared to previous years&#44; reached 20&#46;2&#37; for men and 11&#46;6&#37; for women&#44; figures much lower than those of our study&#46; These figures must influence the low number of patients who work and the associated difficulty in achieving independence&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">The 75 pediatric patients still being monitored in our Pediatric Nephrology unit&#44; are attending school except for one &#40;illiterate&#41;&#44; and although some of them are in lower grades than they would correspond to their ages&#44; they have higher educational levels than recorded in the older patients&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">We did not obtain survey answers from 68 adult patients&#44; so our data may have some bias depending on the current situation of patients who have not participated or the memories they had of their passage through child nephrology&#46; However&#44; we do have their early medical characteristics &#40;age at first transplant&#44; etiology of their kidney failure&#44; current clinical data&#8230;&#41;&#44; and found no significant differences in these elements between non-respondents and respondents&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">There is no universal concept of quality of life&#44; nor a single instrument to measure it&#46; It depends&#44; to a large extent&#44; on the scale of values of the person and the emotional and personal resources of each one&#46; We started this work with the intention of knowing what our patients&#39; perception of their lives was&#44; if after transplantation at pediatric ages - in their opinion - they achieved a life similar to that of the general population&#46; We wanted to know the personal situation of each patient&#44; their way of life&#44; their social skills&#44; their psychological development&#44; what they wanted to tell us&#46; That is why we used directed but open-ended questions&#46; We have attempted to conduct fundamentally qualitative research&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> Perhaps if we had used some of the existing questionnaires &#40;WHOQOL-100 or BREF&#44; SEIQoL-DW&#8230; or other more specific ones&#44; such as the <span class="elsevierStyleItalic">Kidney Disease Quality of Life</span> &#91;KDQOL&#93;&#44; used by other authors<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a>&#41; it would have been easier to communicate and compare our results&#46; Thus&#44; it has been a very difficult task to summarize and draw conclusions with statistical support&#44; but we consider it worthwhile to know what life is like after a first kidney transplant performed in childhood&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">What emerges from their answers and testimonies&#44;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> some of which we collect in this article&#44; is that&#44; although many of them have been&#44; not only been able to adapt to transplantation&#44; but to achieve psychological and emotional growth to have a satisfactory life similar to healthy individuals or even with more motivation and energy&#44; they are still chronically ill&#44; several of them with behavioral problems&#44; difficulties with attention and learning and episodes of anxiety and depression&#46; This coincides with the conclusions reported in other publications&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a></p><p id="par0230" class="elsevierStylePara elsevierViewall">Both&#44; patients and their families need support&#44; especially the latter&#44; given the impact of caring for these patients&#44; at least until they became adults&#44; in their own timeframe&#44; their family dynamics&#44; their level of stress&#44; and their quality of life&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">As has already been fully demonstrated&#44; kidney transplant is the best option for these patients&#44; and a functioning transplant allows them to resume their rhythm and quality of life&#44; increasing their survival and improving their growth and development&#46; But as has already been reflected in other works&#44;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16&#44;17</span></a> there is a social perception that kidney transplant in these patients represents a total cure for their kidney failure&#44; enabling them to resume a life without limitations&#59; this is not so&#58; it is the best treatment we can offer them&#44; but the quality of life they achieve in the long term and the rehabilitation of many of them is still insufficient&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusions</span><p id="par0240" class="elsevierStylePara elsevierViewall">Kidney transplant patients are chronically ill&#46;</p><p id="par0245" class="elsevierStylePara elsevierViewall">Even with the enormous improvement in the survival of pediatric kidney transplant patients during childhood and their grafts&#44; and the good adaptation of some of them to their disease&#44; many others have serious difficulties in achieving good social development and independence&#46; More funds and social support are needed to ensure that they have greater support from therapeutic teams -both themselves and their families- that include pedagogical counselors&#44; psychologists&#44; and social workers&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Testimonials</span><p id="par0250" class="elsevierStylePara elsevierViewall">&#8226; I have received your letter&#44; it gave me great joy&#46; I&#39;m already 45 years old&#46; I started my illness at the age of 11&#46; My first transplant lasted 11 and a half years&#46; Five years after the intervention I had a rejection&#44; but the kidney lasted 6 and a half more years&#46; I went back on dialysis during 1 year and 4 months&#44; and I was transplanted again 18 years ago&#44; and everything was perfect thanks to my donor&#46; I got married&#44; I did not have children&#44; I completed basic school and courses in sewing and hairdressing&#46; I live with my mother and my husband&#46; The truth is&#44; I don&#39;t do much sport because I wear hip prostheses&#44; and previously I had another on my femur&#46; I don&#39;t have any food problems&#46; Although my family is short&#44; I am the shortest and I am self-conscious about my body&#59; my illness has influenced me a lot&#46; My life has been difficult&#46;</p><p id="par0255" class="elsevierStylePara elsevierViewall">When this confinement thing ends&#44; I&#39;ll go to the hospital&#46; I want to visit my doctors and nurses from my childhood&#46; A million thanks for sending me this letter&#44; it has made me super happy today&#46;</p><p id="par0260" class="elsevierStylePara elsevierViewall">&#8226; What a joy to receive these types of letters&#46; Of course I remember all of you&#46; I hope you are all doing very well&#44; and now more so&#44; with everything we are experiencing&#46;</p><p id="par0265" class="elsevierStylePara elsevierViewall">I&#39;m great&#44; in November I&#39;ll have been transplanted for 13 years&#46; I have myomas in the uterus&#44; but it is something that does not worry me at the moment&#44; and with the checkups they always have me under control&#46; At the end of 2018 I was very ill&#44; with a <span class="elsevierStyleItalic">Clostridium</span> infection&#44; what a cursed time&#8230; there were bad months&#44; my lab values were out of control with the bacteria until the end of 2019&#44; but I&#8217;m here&#44; still in the fight&#44; and still have a way to go&#46; I think that my very positive character makes me take things differently&#46;</p><p id="par0270" class="elsevierStylePara elsevierViewall">In December of last year I finished studying dental prosthesis&#44; and I continue training and studying&#59; in 2010 I became a pharmacy technician&#44; but I am still looking for work&#44; things are very tough&#46; I still live with my parents&#46;</p><p id="par0275" class="elsevierStylePara elsevierViewall">I am happy&#44; I live a life totally like a healthy person with two kidneys&#44; and I even think that I am even doing better than some other people&#44; I take a lot of care of myself&#46; I do a lot of sport&#44; because I feel very good about myself&#44; and my partner&#44; apart from his work&#44; is dedicated to fitness&#44; and you can imagine&#46; With food I take good care of myself and I don&#39;t usually go overboard&#46; Whenever I go to check-ups&#44; people ask me if I am the transplant recipient&#44; because nothing is noticeable to me&#44; and it is true that other patients do not have the quality of life that I have due to many factors&#46;</p><p id="par0280" class="elsevierStylePara elsevierViewall">My physical development is not something I&#39;ve ever worried about&#59; I&#39;m short but&#44; hey&#44; nothing that a pair of good heels can&#8217;t fix&#46;</p><p id="par0285" class="elsevierStylePara elsevierViewall">And that&#8217;s all&#44; I encourage the little ones you have there or the teenagers to try to live a happy and &#8220;normal&#8221; life within their possibilities&#44; encourage them to study and train&#46; Things are bad&#44; but anything could happen in this life and change you overnight&#46; Above all&#44; as I said before&#44; be very positive&#46;</p><p id="par0290" class="elsevierStylePara elsevierViewall">Please keep in touch&#46; A very big hug for the whole team and thank you always&#46;</p><p id="par0295" class="elsevierStylePara elsevierViewall">&#8226;&#8230; I am currently well&#44; thank God and my kidney is working perfectly&#46; I walk for an hour every day&#46; I stopped studying&#44; I didn&#39;t finish the intermediate grades &#40;ESO&#41;&#44; and now I&#39;m studying to try to finish it&#46; I also work on whatever comes up&#46;</p><p id="par0300" class="elsevierStylePara elsevierViewall">My transition to the adult hospital was very good&#44; although it took me a while to adapt to the change&#46;</p><p id="par0305" class="elsevierStylePara elsevierViewall">Personally&#44; I live with my partner in his home and town&#59; he takes very good care of me&#46; At the moment&#44; we have no children&#46;</p><p id="par0310" class="elsevierStylePara elsevierViewall">As soon as things get better&#44; I&#39;ll stop by to say hello&#44; as that hospital was my home for many years&#46; Virtual kisses&#46;</p><p id="par0315" class="elsevierStylePara elsevierViewall">&#8226;&#8230; I am the mother of &#8230;&#44; I am writing these lines to tell you that he is fine&#44; very tired of being on dialysis again&#44; but it seems that that is what we have to face&#46; He has many antibodies and they cannot find a kidney for him&#46;</p><p id="par0320" class="elsevierStylePara elsevierViewall">His life is not too good&#44; because he has been on dialysis for 13 years&#44; so he does not work&#44; he lives with us&#44; now he exercises a lot&#44; he is in the gym and he goes for walks&#46; He had a friend&#44; but she was on dialysis like him and one day she passed away&#46; His studies are just as bad&#44; he has not even obtained his driver&#39;s license&#46; As far as diet&#44; he eats now more or less what he used to eat&#46;</p><p id="par0325" class="elsevierStylePara elsevierViewall">Now they say that he has it very difficult and we don&#39;t know what to do&#44; he comes super tired&#44; with the spirit that characterizes him&#44; and I see him some days and I don&#39;t know what to think&#46;</p><p id="par0330" class="elsevierStylePara elsevierViewall">You don&#39;t know how grateful I am for your letter&#8230;</p><p id="par0335" class="elsevierStylePara elsevierViewall">&#8226; &#8230; In December&#44; 32 years ago&#44; I had a kidney transplant and I&#39;m still fine&#46; I didn&#39;t get to study anything serious&#44; I work as a housewife&#46; I spent a few years working in a hotel&#46; I got married 21 years ago&#44; and I have a 15-year-old son&#59; it was a great pregnancy&#44; and then I had a couple of miscarriages&#46; I live at home with my husband and son&#44; within my limitations I live happily&#44; and my life does not change much from that of others&#46; My physical development has been normal&#44; although it caught me in full growth development&#46; I don&#39;t do any sports&#44; although I walk&#46; My diet is normal&#44; I eat everything&#44; yes&#44; with low amounts of salt&#59; I have high blood pressure due to the narrowing of the kidney vein that was transplanted to me&#44; so I have had several dilations&#59; in the last one they put in a coil&#46;</p><p id="par0340" class="elsevierStylePara elsevierViewall">&#8226; &#8230; I have been transplanted for 26 years&#46; I suffered a lot of bullying because of my appearance both by classmates and teachers&#44; I never wanted to go to school or high school because of that&#46; I could not finish my studies&#44; and in my adult life I still carry those mental problems from my childhood&#46; I only got to third-year of ESO&#46; So my studies are basic&#46; I took a course to be a kindergarten and playroom assistant &#40;because I love children&#41;&#46; I took three months of practical training and I spent the whole time from virus to virus&#44; and I had to leave it&#46;</p><p id="par0345" class="elsevierStylePara elsevierViewall">I took a makeup course and I&#39;m currently doing that for a living&#46;</p><p id="par0350" class="elsevierStylePara elsevierViewall">I have had a stable partner for 10 years&#59; I do not have children&#44; but I would love it&#44; it would be a dream for me&#46;</p><p id="par0355" class="elsevierStylePara elsevierViewall">I live with my parents&#44; but I spend several days with my partner&#46;</p><p id="par0360" class="elsevierStylePara elsevierViewall">&#8226;&#8230; When my son&#44; after the transplant and his recovery at home&#44; returned to his elementary studies&#44; it was not as we would have liked it as parents&#44; and it is not because he suffered some kind of rejection or misunderstanding from his classmates&#44; at all&#44; it was because he felt bad because his classmates had moved on and he looked a lot &#8220;older&#8221; with the new classmates&#46; So we went through a bad times that ended with dropping out of school&#46;</p><p id="par0365" class="elsevierStylePara elsevierViewall">It was a stage of adaptation for everyone to the new situation&#44; for him and for us&#44; wanting to do the best for him and not knowing what was best&#46;</p><p id="par0370" class="elsevierStylePara elsevierViewall">&#8226; I tell you about my experience in the children&#39;s unit of the Virgen del Roc&#237;o&#58; until I reached adolescence I did not realize my situation&#44; although as a child they always explained everything to me very well and I did not have any &#8220;trauma&#8221;&#59; on the contrary&#44; whenever I remember something they are good memories&#44; but I think that the boys and girls who are entering adolescence should have a psychologist&#44; and with the new technologies so many trips and visits to the hospital should be avoided&#46;</p><p id="par0375" class="elsevierStylePara elsevierViewall">Regarding my studies&#44; I had some problems in school but I managed to complete my intermediate school &#40;ESO&#41; and a more advanced course in marketing&#44; business&#44; and e-commerce&#46; Currently I am not working because I am back on dialysis&#44; but I want to finish the course internship and get to work&#46;</p><p id="par0380" class="elsevierStylePara elsevierViewall">Fortunately&#44; I met a wonderful girl 4 years ago with whom I am very happy&#44; who supports me and understands me&#46;</p><p id="par0385" class="elsevierStylePara elsevierViewall">I still live with my parents&#44; because I don&#39;t have a job&#44; but I would like to become independent soon&#46;</p><p id="par0390" class="elsevierStylePara elsevierViewall">The truth is that I am happy with my life&#44; although it differs a lot from that of my friends&#44; who&#44; at my same age&#44; have their jobs and their lives are very different&#46;</p><p id="par0395" class="elsevierStylePara elsevierViewall">I don&#39;t usually do much sport&#44; I&#39;ve always been a very sedentary boy&#44; but it doesn&#39;t stop me from taking care of my diet and I always try to control my weight&#46;</p><p id="par0400" class="elsevierStylePara elsevierViewall">The eating habits on dialysis are much stricter&#44; both because of the food and the drink&#44; and I have to control myself much more so as not to carry too much weight on the days of dialysis&#44; and there are foods that I cannot take&#46;</p><p id="par0405" class="elsevierStylePara elsevierViewall">The kidney issue has influenced my development&#58; I could have been somewhat taller&#46;</p><p id="par0410" class="elsevierStylePara elsevierViewall">&#8226; &#8230; Regarding my personal life&#44; I am still at my parents&#39; house&#44; without a partner and I obtained my school certificate a year ago at adult school&#44; but starting with COVID my life stagnated again&#46; My physical development has been adequate with respect to my family&#44; in size and weight&#46; But my life&#44; compared to that of people my age&#44; is very different&#44; I do not carry out the activities that a person of my age could do&#59; the whole problem has affected my personal life&#44; but I try to carry on as well as I can&#8230;</p><p id="par0415" class="elsevierStylePara elsevierViewall">&#8226; Since you transferred me to adult clinic&#44; everything about the kidney is very good so far&#44; and God-willing it will continues this way&#44; I am very responsible with my treatment&#46; I still hear badly&#46;</p><p id="par0420" class="elsevierStylePara elsevierViewall">After 5 years of transplantation&#44; in 2009&#44; I was diagnosed with a bulb cavernoma due to bleeding in the brain&#59; I was very ill and half my body was paralyzed&#44; I did not see well&#44; I had double vision&#46; After a year it happened again&#44; in the area where it was they could not operate&#44; and I spent two years until I recovered&#46;</p><p id="par0425" class="elsevierStylePara elsevierViewall">Thank God the cavernoma was absorbed slowly&#44; and since then I have been followed up every year and have an MRI&#46; The secuela that has stuck with me is that if I look sideways I see double&#59; otherwise everything is fine&#44; despite the fact that I had a very bad time&#46;</p><p id="par0430" class="elsevierStylePara elsevierViewall">About studies&#44; I missed many classes and courses&#44; I did not make enough progress&#44; it was very difficult for me to memorize and study&#44; with the problem of hearing it is very difficult for me to grasp and understand things&#46; I got my ESO certificate with a lot of effort and help from my mother and teachers&#46; When I recovered from the paralysis&#44; I got my driver&#39;s license&#44; which also was difficult and it took a lot of effort&#46;</p><p id="par0435" class="elsevierStylePara elsevierViewall">As for work&#44; I dedicated myself to going with my father to fix gardens and swimming pools&#44; and I&#39;m still with him&#46;</p><p id="par0440" class="elsevierStylePara elsevierViewall">I don&#39;t currently have a partner or children&#59; I had two partners&#44; but it didn&#39;t go well&#46; I live with my parents and I have never been independent&#46;</p><p id="par0445" class="elsevierStylePara elsevierViewall">I am happy&#44; I get along very well with my parents&#44; my sister and my friends&#44; but my friends&#44; unlike me&#44; perform much better in all aspects of life&#46; Sometimes I ride my bike or play football&#46; I have no eating problems and I like all kinds of food&#46; My physical development has not been the one that would correspond to me in size or weight&#46;</p><p id="par0450" class="elsevierStylePara elsevierViewall">I would consider that it would be very good if there were psychologists in hospitals&#44; since it is very hard to live this situation and spend so many years in the hospital or visiting hospitals&#44; since I have not stopped since birth&#46; This whole situation&#44; everything I have experienced&#44; has created dependence on my parents and I am not able to take care of myself independently&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Funding</span><p id="par0455" class="elsevierStylePara elsevierViewall">This work has not received any grants or scholarships from public or commercial agencies or non-profit entities&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflict of interests</span><p id="par0460" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare&#46;</p></span></span>"
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            0 => "Trasplante renal"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction and objectives</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">There is currently no doubt that a kidney transplant with good function is the best treatment we can offer a child with severe kidney failure&#44; improving their growth&#44; development and life in general&#46; But there are few works that follow these patients over the years to find out what their life is like as adults&#44; their achievements and if there are any difficulties that may have arisen from their illness&#46; That has been the objective of this work&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">We have collected the evolution of 287 patients who received at least one kidney transplant in pediatric age&#44; analyzing not only the survival of grafts and recipients but&#44; fundamentally&#44; their current quality of life&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Over a 40-year period &#40;1979&#8722;2019&#41;&#44; 345 kidney transplants were performed in 287 pediatric recipients&#44; with a rate of retransplantation before reaching the age of majority of 16&#46;7&#37;&#46; Survival&#44; both of patients and grafts&#44; has improved remarkably in the last 20 years&#46; The survival of transplanted patients in the period from 1979 to 1996 at 10&#44; 20 and 25 years after the intervention was 83&#37;&#44; 76&#37; and 65&#37; respectively&#44; and 94&#37; and 82&#37; at 10 and 20 years respectively in those transplanted in the period from 1997 to 2019&#46; Graft survival in the period from 1979 to 1996 at 10 and 20 years was 39&#37; and 18&#37;&#44; increasing in the second period to 68&#37; and 34&#37; respectively&#46; Survival of the first living donor graft &#40;LD&#41; at 5 and 10 years was 94&#37; and 89&#37;&#46; Currently 150 of these patients are adults&#46; Of these&#44; 32&#37; have a stable partner and 6&#46;6&#37; have children&#46; The level of training is lower than that of the general population and many of them have other comorbidities&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">The life expectancy of pediatric patients with kidney failure transplanted during childhood has improved markedly in recent decades&#44; as has graft survival&#44; being better with a living donor&#46; In general&#44; they consider themselves satisfied with their lives&#44; with great acceptance of their illness and limitations&#44; but -analyzing their testimonies- we conclude that they lack social support&#44; both for themselves and their families&#44; to achieve a higher level of education and better quality of life&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n y objetivos</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Actualmente no hay duda de que un trasplante renal con buena funci&#243;n es el mejor tratamiento que podemos ofrecer a un ni&#241;o con insuficiencia renal severa&#44; mejorando su crecimiento&#44; desarrollo y actividad en general&#46; Pero hay pocos trabajos que sigan a estos pacientes a lo largo de los a&#241;os para conocer c&#243;mo es su vida de adultos&#44; sus logros y si hay dificultades que han podido derivarse de su enfermedad&#46; Ese ha sido el objetivo de este trabajo&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Hemos recogido la evoluci&#243;n de 287 pacientes que recibieron al menos un trasplante renal en edad pedi&#225;trica en nuestra unidad&#44; analizando no solo la supervivencia de los injertos y receptores sino&#44; fundamentalmente&#44; su calidad de vida actual&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">En un periodo de 40 a&#241;os &#40;1979&#8722;2019&#41; se realizaron 345 trasplantes renales en 287 receptores pedi&#225;tricos&#44; con una tasa de retrasplantes antes de cumplir la mayor&#237;a de edad del 16&#44;7&#37;&#46; La supervivencia&#44; tanto de los pacientes como de los injertos&#44; ha mejorado notablemente en los &#250;ltimos 20 a&#241;os&#46; La supervivencia de los pacientes trasplantados en el periodo de 1979 a 1996 a los 10&#44; 20 y 25 a&#241;os de la intervenci&#243;n fue del 83&#37;&#44; 76&#37; y 65&#37; respectivamente&#44; y del 94&#37; y 82&#37; a los 10 y 20 a&#241;os respectivamente en los trasplantados en el periodo de 1997 a 2019&#46; La supervivencia del injerto en el periodo de 1979 a 1996 a los 10 y 20 a&#241;os fue del 39&#37; y 18&#37;&#44; aumentando en el segundo periodo al 68&#37; y 34&#37; respectivamente&#46; La supervivencia del primer injerto con donante vivo &#40;DV&#41; a los 5 y 10 a&#241;os fue del 94&#37; y 89&#37;&#46;</p><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Actualmente son adultos 150 de estos pacientes&#46; De ellos&#44; 32&#37; tienen pareja estable y 6&#44;6&#37; tienen hijos&#46; El nivel de formaci&#243;n es menor que el de la poblaci&#243;n general y muchos de ellos tienen otras comorbilidades&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">La esperanza de vida de los pacientes pedi&#225;tricos con insuficiencia renal trasplantados durante la infancia ha mejorado notablemente en las &#250;ltimas d&#233;cadas&#44; as&#237; como la supervivencia de los injertos&#44; siendo mejor con donante vivo&#46; En general&#44; ellos se consideran satisfechos con su vida&#44; con gran aceptaci&#243;n de su enfermedad y limitaciones&#44; pero -analizando sus testimonios- concluimos que les falta apoyo social&#44; tanto a ellos como a sus familias&#44; para lograr un nivel educativo m&#225;s alto y mejor calidad de vida&#46;</p></span>"
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#60;5&nbsp;\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">55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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"><span class="elsevierStyleHsp" style=""></span>5 a &#60;10&nbsp;\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">89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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"><span class="elsevierStyleHsp" style=""></span>10 a &#60;15&nbsp;\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">156&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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"><span class="elsevierStyleHsp" style=""></span>15 a &#8804;18&nbsp;\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">45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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"><span class="elsevierStyleItalic">Weight&#160;&#60;&#160;15&#160;kg&#44; n &#40;&#37;&#41;</span>&nbsp;\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">55 &#40;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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_colgroup " colspan="2" 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 colgroup " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Etiology IRT&#44; n &#40;&#37;&#41;</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"><span class="elsevierStyleHsp" style=""></span>Structural anomalies&nbsp;\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">105 &#40;36&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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"><span class="elsevierStyleHsp" style=""></span>Congenital &#47; hereditary diseases&#46;&nbsp;\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">64 &#40;22&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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"><span class="elsevierStyleHsp" style=""></span>Glomerulopathies&#46;&nbsp;\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">62 &#40;21&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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"><span class="elsevierStyleHsp" style=""></span>Vascular&nbsp;\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">28 &#40;9&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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"><span class="elsevierStyleHsp" style=""></span>First transplant&#46;&nbsp;\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">287&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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"><span class="elsevierStyleHsp" style=""></span>Retransplant&nbsp;\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">58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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_colgroup " colspan="2" 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 colgroup " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Dialysis &#40;D&#41; preTx&#44; n &#40;&#37;&#41;</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"><span class="elsevierStyleHsp" style=""></span>D&#46; peritoneal&#46;&nbsp;\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">129 &#40;37&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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"><span class="elsevierStyleHsp" style=""></span>Hemodialysis&nbsp;\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">146 &#40;42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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"><span class="elsevierStyleHsp" style=""></span>D&#46; peritoneal &#47; HD&#46;&nbsp;\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">7 &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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"><span class="elsevierStyleHsp" style=""></span>Predialysis&nbsp;\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">63 &#40;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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"><span class="elsevierStyleHsp" style=""></span>Average time on dialysis &#40;months&#41;&#46;&nbsp;\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">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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"><span class="elsevierStyleHsp" style=""></span>Donor type &#40;D&#41;&#44; n &#40;&#37;&#41;&#59; cadaver &#40;C&#41; &#47; living &#40;V&#41;&#46;&nbsp;\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">DC 302 &#40;87&#46;5&#41;&#59; DV 43 &#40;12&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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_colgroup " colspan="2" 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 colgroup " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Immunosuppression&#44; n &#40;&#37;&#41;</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"><span class="elsevierStyleHsp" style=""></span>Cyclosporine &#47; tacrolimus&#46;&nbsp;\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">119 &#40;34&#41; &#47; 223 &#40;65&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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"><span class="elsevierStyleHsp" style=""></span>Azathioprine &#47; MMF&#46;&nbsp;\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">90 &#40;26&#41; &#47; 253 &#40;73&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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"><span class="elsevierStyleHsp" style=""></span>Prednisone&nbsp;\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">345 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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"><span class="elsevierStyleHsp" style=""></span>IL-2 receptor&#46;O&nbsp;\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">251 &#40;73&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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"><span class="elsevierStyleHsp" style=""></span>Thymoglobulin &#47; OKT3&#46;&nbsp;\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">58 &#40;17&#41; &#47; 5&#40;1&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  \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">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n&nbsp;\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
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                  \t\t\t\t">Infectious&nbsp;\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
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                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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">Cerebral vascular accident&nbsp;\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">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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">Acute hemorrhage&nbsp;\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">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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">Cardiac pathology&nbsp;\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">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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">Tumor&nbsp;\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">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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">Generalized oxalosis&nbsp;\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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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">Respiratory&nbsp;\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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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">Extreme cachexia&nbsp;\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">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                0 => "xTab3383538.png"
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          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Causes of death&#46;</p>"
        ]
      ]
      6 => array:8 [
        "identificador" => "tbl0020"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
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          0 => array:3 [
            "identificador" => "at0035"
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          "leyenda" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Units&#58; years&#46;</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Source&#58; Mortality tables&#44; INE&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Available at&#58; <span class="elsevierStyleInterRef" id="intr0005" href="https://www.ine.es/jaxi/Datos.htm?path=/t00/mujeres_hombres/tablas_1/l0/&amp;file=d01005.px">https&#58;&#47;&#47;www&#46;ine&#46;es&#47;jaxi&#47;Datos&#46;htm&#63;path&#61;&#47;t00&#47;mujeres&#95;hombres&#47;tablas&#95;1&#47;l0&#47;&#38;file&#61;d01005&#46;px</span>&#46;</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="\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">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2019</th><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2009</th></tr><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">&nbsp;\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">Men&nbsp;\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">Women&nbsp;\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">Gender gap &#40;women-men&#41;&nbsp;\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">Men&nbsp;\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">Women&nbsp;\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">Gender gap &#40;women-men&#41;&nbsp;\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">At birth&nbsp;\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">80&#46;9&nbsp;\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">86&#46;2&nbsp;\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">5&#46;4&nbsp;\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">78&#46;6&nbsp;\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">84&#46;7&nbsp;\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">6&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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">10 years&nbsp;\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">71&#46;2&nbsp;\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">76&#46;5&nbsp;\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">5&#46;3&nbsp;\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">69&#46;0&nbsp;\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">75&#46;0&nbsp;\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">6&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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">20 years&nbsp;\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">61&#46;3&nbsp;\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">66&#46;6&nbsp;\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">5&#46;3&nbsp;\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">59&#46;1&nbsp;\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">65&#46;1&nbsp;\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">5&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab3383534.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Life expectancy at different ages by period&#46; Gender gap&#46; Spain&#46;</p>"
        ]
      ]
      7 => array:8 [
        "identificador" => "tbl0025"
        "etiqueta" => "Table 5"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0040"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\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">&nbsp;\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">Number of patients &#47; Period&nbsp;\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">10 years&nbsp;\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">20 years&nbsp;\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">Davidovits M&#46;&#44; Pediatr Nephrol&#44; 2021&#44; Israel&nbsp;\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">545 &#40;1981&#8722;2017&#41;&nbsp;\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">DV&#58; 94&#46;8&#59; DC&#58; 89&#46;9&nbsp;\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">DV&#58; 91&#46;4&#59; DC&#58; 80&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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">Mumford L&#46;&#44; Transpl Int&#44; 2019&#44; United Kingdom&#46;&nbsp;\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&#46;912 &#40;1987&#8722;2016&#41;&nbsp;\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">93&nbsp;\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">84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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">Sypek M&#46;P&#46;&#44; Pediatr Transpl&#44; 2021&#44; Australia&nbsp;\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">1989&#8722;1998&nbsp;\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">81&nbsp;\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">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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">&nbsp;\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">1999&#8722;2008&nbsp;\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">89&nbsp;\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">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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">&nbsp;\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">2009&#8722;2018&nbsp;\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">98&nbsp;\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">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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">Cordinh&#224; C&#46;&#44; Transplant Proc&#44; 2019&#44; Coimbra&nbsp;\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">104 &#40;1981&#8722;2016&#41;&nbsp;\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">92&#46;7&nbsp;\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">85&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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">Fijo J&#46;&#44; Andalusia&nbsp;\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">287 &#40;1979&#8722;2019&#41;&nbsp;\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">1979&#8722;1996&#58; 83&nbsp;\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">1979&#8722;1996&#58; 76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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">&nbsp;\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">&nbsp;\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">1997&#8722;2019&#58; 94&nbsp;\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">1997&#8722;2019&#58; 82&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3383536.png"
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Patient survival &#40;&#37;&#41;&#46;</p>"
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      ]
      8 => array:8 [
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        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0045"
            "detalle" => "Table "
            "rol" => "short"
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        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\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">&nbsp;\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">Number of transplants&#47;Period&nbsp;\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">5 years&nbsp;\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">10 years&nbsp;\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">20 years&nbsp;\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">Davidovits M&#46;&#44; Pediatr Nephrol&#44; 2021&#44; Israel<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&nbsp;\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">599 &#40;1981&#8722;2017&#41;&nbsp;\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">DV&#58; 87&#46;9&nbsp;\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">75&#46;2&nbsp;\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">47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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">&nbsp;\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">&nbsp;\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">DC&#58; 77&nbsp;\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">60&#46;7&nbsp;\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">38&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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">Mumford L&#46;&#44; Transpl Int&#44; 2019&#44; United Kingdom&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&nbsp;\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">3&#46;236 &#40;1987&#8722;2016&#41;&nbsp;\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">All&#58; 79&nbsp;\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">65&nbsp;\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">42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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">&nbsp;\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">&nbsp;\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">DV&#58; 89&nbsp;\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">74&nbsp;\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">49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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">&nbsp;\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">&nbsp;\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">DC&#58; 75&nbsp;\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">61&nbsp;\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">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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">Sypek M&#46;P&#46;&#44; Pediatr Transpl&#44; 2021&#44; Australia<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&nbsp;\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">426 &#40;1989&#8722;2018&#41;&nbsp;\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">&nbsp;\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">&nbsp;\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">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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">&nbsp;\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">&#40;1999&#8722;2008&#41;&nbsp;\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">65&nbsp;\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">49&nbsp;\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">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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">&nbsp;\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">&#40;2009&#8722;2018&#41;&nbsp;\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">85&nbsp;\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">70&nbsp;\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">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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">Cordinh&#224; C&#46;&#44; Transplant Proc&#44; 2019&#44; Coimbra<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&nbsp;\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">111 &#40;1981&#8722;2016&#41;&nbsp;\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">79&#46;7&nbsp;\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">74&#46;3&nbsp;\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">52&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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">NAPRTCS&#44; 2018&#44; USA&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&nbsp;\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">428 &#40;2012&#8722;2017&#41;&nbsp;\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">DV&#58; 94&#46;9&nbsp;\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
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">DC&#58; 90&#46;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fijo J&#46;&#44; Andalusia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">345 &#40;DC&#160;&#43;&#160;DV&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1979&#8722;1996 60&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1997&#8722;2019 80&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">34&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">DV&#58; &#40;2005&#8722;2019&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">94&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">89&nbsp;\t\t\t\t\t\t\n
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                      "titulo" => "Pediatric kidney transplantation&#58; experience of a center over 4 decades"
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                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Cordinh&#224;"
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                            2 => "C&#46; Carmo"
                            3 => "C&#46; Gomes"
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                      "doi" => "10.1016/j.transproceed.2019.05.007"
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Original article
Life after a pediatric kidney transplant
Vida tras un trasplante renal pediátrico
Julia Fijo
Corresponding author
juliaflv12@gmail.com

Corresponding author.
, Ana Sánchez-Moreno
Unidad de Nefrología Pediátrica, Hospitales Universitarios Virgen del Rocío, Sevilla, Spain
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so the individual will need several grafts over their lifetime&#44; with periods of organ malfunction that will require returning to multiple treatments in addition to the usual treatment with immunosuppressants&#44; more frequent visits and medical checks and&#44; most likely&#44; new periods of treatment by dialysis&#46; That is&#44; with a kidney transplant we do not &#8220;cure&#8221; a pediatric patient with kidney failure&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">What happens to these patients next&#44; when we transfer them to adult units upon reaching the age of adulthood&#63; What is their life expectancy&#63; What problems have they encountered throughout their lives&#63; Do they achieve an &#8220;acceptable&#8221; quality of life&#63;</p><p id="par0020" class="elsevierStylePara elsevierViewall">There are few studies on these issues&#44; probably because it is difficult to conduct multiple follow-ups across different units&#44; different hospitals&#44; and different cities over many years&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Currently&#44; the great development of computer science and communication has facilitated long-term monitoring of this population&#44; allowing us to better understand the lives of these children and adults&#44; and thus&#44; perhaps&#44; we can consider new challenges to improve their quality of life&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">With this idea&#44; 40 years since the beginning of the kidney transplant program in the pediatric unit of the hospital where we work&#44; we have tried to synthesize the lives of our patients&#44; reflecting&#44; more than their clinical-analytical data&#44; their development and their achievements&#44; in order to know what we are offering when we transplant these patients and what we can do to improve their futures&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><p id="par0035" class="elsevierStylePara elsevierViewall">Retrospectively&#44; through medical records - initially on paper&#44; later in computer databases- and prospectively&#44; through outpatient medical visits&#44; through emails or postal mail and telephone calls&#44; we have monitored the 345 pediatric kidney transplants conducted by the Pediatric Nephrology unit of the Virgen del Roc&#237;o University Hospitals&#44; in Seville&#46; The study covered a period of time of 40 years since the beginning of the transplant program in our unit&#46; Patients were transferred to the adult units closest to their places of residence at the age of 18&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Through the medical records we have collected the deaths and the current clinical situation of the patients to study the survival of both the graft and the patient&#46; Through conversations with them&#44; emails and phone calls&#44; we have asked them&#44; including those of adult age and transferred to adult services&#44; the questions that are included in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> to learn some aspects of their quality of life over time&#44; which was what most interested us&#44; also encouraging them to tell us what they wanted about themselves and if they were satisfied&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">We defined comorbidity as the involvement of at least one organ other than the kidney&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The first pediatric kidney transplant in our hospital was performed on June 1&#44; 1979&#44; and we have collected in this work all transplants performed since then until June 1&#44; 2019&#44; 40 years later&#44; with a minimum follow-up time of one year in all patients&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Graft and recipient survival data have been analyzed with the IBM SPSS Statistics 20&#46;0 statistical program&#44; estimating patient and graft survival using the Kaplan-Meier method&#46; We consider patient survival the period elapsed from the first graft until death&#44; regardless of whether they have been transplanted on more than one occasion&#44; since what we want to highlight fundamentally in this work is the future change in quality of life of these patients&#44; from when their kidney function declines to the point of requiring a transplant&#44; currently considered the ideal treatment&#46; The survival of the grafts&#44; measured from the time of transplantation until restarting dialysis or needing a new graft&#44; is calculated from the total of those implanted in each period without taking into account whether it was the first or a retransplant&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0060" class="elsevierStylePara elsevierViewall">In these 40 years of activity in child kidney transplantation&#44; 345 transplants were performed in 287 patients under 18 years of age&#44; with ages ranging from 1&#46;5 years in the case of the youngest patient to 17&#46;8 years for the oldest&#46; The smallest weighed 8&#46;9&#160;kg&#46; The main characteristics of the population studied are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Today we have lost track of 17 of these 287 patients&#44; so we do not know their current situation&#46; But we do know that of the remaining 270&#44; 45 have died&#44; that is&#44; the mortality rate has been 16&#46;66&#37; of patients in these 40 years&#46; The youngest died at the age of 1&#46;5 years&#44; and the oldest is 37&#46;5 years old&#46; The median age at death was 19 years&#44; with a median time since the first transplant of 9 years &#40;range from 48&#160;hours to 25 years&#41;&#46; Nine of these 45 patients had already received a second graft&#44; 3 of them after being transferred to adult services&#46; Fifteen died with a functioning graft&#44; and the remaining 30 were back on dialysis due to graft failure&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">The causes of death&#44; of which we know 29&#44; are listed in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#59; we highlight that the leading cause is infection&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">We analyzed the survival of grafts and recipients by differentiating two groups&#58; those who received grafts between 1979 and 1996 inclusive&#44; and those who received them from 1997 to 2019&#46; The first group &#40;93 grafts&#44; 77 patients&#41; received as immunosuppressive treatment cyclosporine &#40;with controls of plasma levels with much variability&#41;&#44; azathioprine and prednisone&#59; the second group &#40;252 grafts&#44; 210 patients&#41; received treatment with calcineurins inhibitors &#40;29 with cyclosporine with better controlled levels&#44; the remaining 223 with tacrolimus&#41;&#44; mycophenolate mofetil&#44; and prednisone&#46; Survival&#44; both of the grafts and of the patients&#44; has improved markedly in the second period&#44; as can be seen in <a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1 and 2</a>&#46; Patients transplanted in the period from 1979 to 1996 had a survival of 83&#37;&#44; 76&#37; and 65&#37;&#44; respectively&#44; at 10&#44; 20&#44; and 25 years after the intervention&#46; Survival of transplants in the period 1997&#8211;2019 was 94&#37; and 82&#37;&#44; respectively&#44; at 10 and 20 years &#40;<span class="elsevierStyleItalic">P</span>&#160;&#60;&#160;&#46;01&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">Graft survival in the period from 1979 to 1996 at 10 and 20 years of follow-up was 39&#37; and 18&#37;&#44; respectively&#44; improving in the second period to 68&#37; at 10 years and 34&#37; at 20 years&#46; The median estimated in the first period was 7&#46;36 years&#44; compared to 15&#46;156 years in the second period &#40;<span class="elsevierStyleItalic">P</span>&#160;&#60;&#160;&#46;0001&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Living donor transplants began in our unit in 2005&#44; achieving a total of 43 transplants in 2019&#46; Survival of these grafts&#44; all early transplants&#44; was 89&#37; at 10 years&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Despite this&#44; 48 &#40;16&#44;7&#37;&#41; of the 287 patients had received a second graft before reaching the age of 18 years&#44; 8 of these 48 had been transplanted for the third time and two of these 8 had already received a fourth transplant before reaching adulthood&#44; thus before being transferred to adult nephrology services&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">During the follow-up time in adult services 40 more patients received a second kidney transplant&#44; 14 a third and 2 a fourth and&#44; subsequently&#44; one patient received a fifth graft&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Today&#44; the oldest of these patients would now be 54 years old&#46; The average age of the 225 patients that we know and are currently alive is 21&#46;2 years&#44; ranging from 4 years old to 50 years&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">As of June 1&#44; 2020&#44; 150 patients were already adults &#40;&#62;18 years&#41; and 114 of them were &#8805;25 years of age&#44; excluding the deceased and those lost to follow-up&#46; On the other hand&#44; 75 patients had not yet reached the age of 18&#46; One hundred and eighty-two had a working graft &#40;81&#37;&#41;&#44; with the remaining 43 &#40;19&#37;&#41; undergoing chronic dialysis treatment&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Eighty two out of the 150 adult patients responded to our survey&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Of these&#44; 31 &#40;38&#37;&#41; are married or with a stable partner&#44; only 10 have children &#40;two have two children&#44; the rest one&#41;&#59; 32 of them &#40;39&#37;&#41; are living independently from their families&#44; with or without a partner&#46; Some &#40;16&#37;&#41; highlighted their short stature &#40;well below that expected by family inheritance&#58; &#60;&#60; P3&#41;&#44; and 4 of them mentioned their obesity&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">In terms of education&#44; only 13 &#40;16&#37;&#41; have higher education and 23 &#40;28&#37;&#41; have a secondary or vocational education&#46; The rest &#40;56&#37;&#41; had studied&#44; at most&#44; until the first stage of secondary education&#46; A 35&#37; &#40;n&#160;&#61;&#160;29&#41; have a job&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Twenty-six percent said that they were happy&#47;satisfied with their quality of life&#59; in their opinion&#44; their lives are similar to those of their friends without chronic disease&#46; Only three reported notable limitations in their lives&#44; although at least 30&#37; of them have other comorbidities or pathologies associated with their kidneys&#44; particularly liver pathologies &#40;10 patients&#44; of which 4 have subsequently undergone liver transplants&#41;&#44; malignancies &#40;13&#41;&#44; severe bone disorders &#40;8 patients&#44; 4 of them with hip and&#47;or knee prostheses&#41;&#44; diabetes &#40;5&#41;&#44; mental disorders &#40;3&#41;&#44; deafness &#40;3&#41;&#44; cataracts &#40;2&#41;&#44; and organic involvement secondary to severe arterial hypertension &#40;2&#41;&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Only 9&#37; exercised regularly&#44; and 5 of the 82 respondents &#40;6&#37;&#41; reported drug addictions&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">With the exception of two patients&#44; all reported that they were happy to learn that we were interested in their lives&#44; their achievements and their expectations&#44; and wanted to share their stories and their difficulties&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">All but one claimed to have good memories of their time in the Pediatric Nephrology unit despite multiple admissions&#44; analytical extractions&#44; treatments&#44; and tests&#46; We include a sample of short selections from their answers at the end of this work&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0145" class="elsevierStylePara elsevierViewall">In our patients&#44; as in other pediatric samples&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> the most frequent etiology that leads a child to require a kidney transplant is congenital structural abnormalities of the urinary system&#44; followed by hereditary diseases&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Life expectancy is the average number of years that a person of a certain age would expect to continue living if the currently observed pattern of mortality by age &#40;mortality rates by age&#41; were maintained&#46; In Spain&#44; between 1999 and 2019 the life expectancy at birth of men has gone from 75&#46;4 to 80&#46;9 years and that of women from 82&#46;3 to 86&#46;2 years&#44; according to the basic demographic indicators published by Spain&#8217;s National Institute of Statistics &#40;June 2020&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">Given the age at transplantation of all the patients collected in this work under 18 years&#44; their average post-transplant life expectancy&#44; according to the European registry&#44; would be 63 years&#44; as shown in <a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#44;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> or according to the life expectancy of the general population by age groups&#44; in Spain&#44; as shown in <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> &#40;somewhat lower in the years we transplanted our first patients&#41;&#46; It is still too early to know how many of our patients will reach those ages&#44; given that the oldest at the time of this study could not have been older than 54 years at the time&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0160" class="elsevierStylePara elsevierViewall">Considering that the mortality rate for the Spanish population in 1996 was 8&#46;75 per thousand inhabitants&#44; it was similar in 2019&#58; 8&#46;83 per thousand inhabitants&#46; In our autonomous community&#44; Andalusia&#44; the mortality rate for the total population in 1996 was somewhat lower&#44; at 8&#46;18 per thousand&#44; remaining at 2019 at 8&#46;35 per thousand&#46; If we examine mortality in Andalusia in the same years for the age group between 1 and 39 years&#44; in 1996 it was 5&#46;76 per thousand inhabitants&#44; having decreased in 2019 to 2&#46;09 per thousand&#46; It is difficult to compare this mortality rate with that obtained in our patients&#44; given the different ages and annual variations&#44; but the average rate obtained roughly over these years&#44; is 4&#46;16 annual deaths per thousand&#46; Although as seen in the survival graphs&#44; both the grafts and the patients have improved survival in the last 20 years&#44; with a higher mortality rate in the period from 1979 to 1996 for the same post-transplant time period &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">This patient survival is similar to those obtained in other pediatric patient samples in the literature<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#8211;6</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>&#41; in the same time period&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0170" class="elsevierStylePara elsevierViewall">To compare the survival of the grafts with those obtained in other samples<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#8211;7</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a>&#41; it must be considered that those collected by other authors are calculated only for first grafts&#44; whose overall survival is often higher than in retransplants&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a> We have not made that distinction&#44; so the average survival of the grafts calculated in this work may be lower due to retransplantation&#46;</p><elsevierMultimedia ident="tbl0030"></elsevierMultimedia><p id="par0175" class="elsevierStylePara elsevierViewall">Of course&#44; we also note that although there has been less follow-up time since the start of living donor transplants in our unit in 2005&#44; and fewer transplants performed&#44; living donor transplants appear to have better survival compared to that of cadaveric donor transplantation&#44; as reported in other pediatric samples&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">It is worth noting the number of patients with onset of kidney failure at an early age who have already received more than one graft when reaching adulthood&#44; which means that many of these patients are sensitized with a high percentage of antibodies&#46; This - coupled with the loss of preference in the waiting lists when they reach adulthood- makes a new transplant more difficult and forces them to remain in dialysis for a long time during early adulthood&#44; with disruptive impacts on their lives&#44; as we see in some of the patient comments&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">The educational level of the adult population<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> &#40;aged 25&#8211;64&#41; is an indicator related to the development and employment levels of current and future society&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">In Spain&#44; in the year 2019&#44; 41&#46;7&#37; of men and 35&#46;7&#37; of women &#40;aged 25&#8211;64&#41; had a 0&#8211;2 level of education corresponding to preschool&#44; primary and first stage of secondary education&#44; with the percentages of the population being lower at higher educational levels&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">By age group&#44; in the population aged 25&#8211;34&#44; 40&#46;6&#37; of men and 52&#46;4&#37; of women have a level of training corresponding to higher education and doctorate &#40;levels 5&#8211;8&#41;&#46; For the same age group&#44; the percentages with a level of training lower than the second stage of secondary education&#44; that is&#44; level 0&#8211;2&#44; are 35&#46;5&#37; in men and 24&#46;8&#37; in women&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">Only 16&#37; of patients in this series have higher education &#40;level 5&#8211;8&#41; and 28&#37; have intermediate or vocational training &#40;level 3&#8211;4&#41;&#59; the remaining 56&#37; have training equivalent to levels 0&#8211;2&#46; Some 42&#37; dropped out of school early&#46; There were no significant differences in the level of education in relation to sex&#46; This differs with some of the few studies that collect this data in the literature&#44; such as Mekahli et al&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> and Rosenkranz et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> which find a high percentage of patients with complete studies and professional studies although with a lower employment rate than the general population&#44; although they are limited to a small group of patients chosen to participate in another study&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">In the year 2020&#44; in Spain&#44; school dropouts&#44; despite having been reduced compared to previous years&#44; reached 20&#46;2&#37; for men and 11&#46;6&#37; for women&#44; figures much lower than those of our study&#46; These figures must influence the low number of patients who work and the associated difficulty in achieving independence&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">The 75 pediatric patients still being monitored in our Pediatric Nephrology unit&#44; are attending school except for one &#40;illiterate&#41;&#44; and although some of them are in lower grades than they would correspond to their ages&#44; they have higher educational levels than recorded in the older patients&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">We did not obtain survey answers from 68 adult patients&#44; so our data may have some bias depending on the current situation of patients who have not participated or the memories they had of their passage through child nephrology&#46; However&#44; we do have their early medical characteristics &#40;age at first transplant&#44; etiology of their kidney failure&#44; current clinical data&#8230;&#41;&#44; and found no significant differences in these elements between non-respondents and respondents&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">There is no universal concept of quality of life&#44; nor a single instrument to measure it&#46; It depends&#44; to a large extent&#44; on the scale of values of the person and the emotional and personal resources of each one&#46; We started this work with the intention of knowing what our patients&#39; perception of their lives was&#44; if after transplantation at pediatric ages - in their opinion - they achieved a life similar to that of the general population&#46; We wanted to know the personal situation of each patient&#44; their way of life&#44; their social skills&#44; their psychological development&#44; what they wanted to tell us&#46; That is why we used directed but open-ended questions&#46; We have attempted to conduct fundamentally qualitative research&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> Perhaps if we had used some of the existing questionnaires &#40;WHOQOL-100 or BREF&#44; SEIQoL-DW&#8230; or other more specific ones&#44; such as the <span class="elsevierStyleItalic">Kidney Disease Quality of Life</span> &#91;KDQOL&#93;&#44; used by other authors<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a>&#41; it would have been easier to communicate and compare our results&#46; Thus&#44; it has been a very difficult task to summarize and draw conclusions with statistical support&#44; but we consider it worthwhile to know what life is like after a first kidney transplant performed in childhood&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">What emerges from their answers and testimonies&#44;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> some of which we collect in this article&#44; is that&#44; although many of them have been&#44; not only been able to adapt to transplantation&#44; but to achieve psychological and emotional growth to have a satisfactory life similar to healthy individuals or even with more motivation and energy&#44; they are still chronically ill&#44; several of them with behavioral problems&#44; difficulties with attention and learning and episodes of anxiety and depression&#46; This coincides with the conclusions reported in other publications&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a></p><p id="par0230" class="elsevierStylePara elsevierViewall">Both&#44; patients and their families need support&#44; especially the latter&#44; given the impact of caring for these patients&#44; at least until they became adults&#44; in their own timeframe&#44; their family dynamics&#44; their level of stress&#44; and their quality of life&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">As has already been fully demonstrated&#44; kidney transplant is the best option for these patients&#44; and a functioning transplant allows them to resume their rhythm and quality of life&#44; increasing their survival and improving their growth and development&#46; But as has already been reflected in other works&#44;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16&#44;17</span></a> there is a social perception that kidney transplant in these patients represents a total cure for their kidney failure&#44; enabling them to resume a life without limitations&#59; this is not so&#58; it is the best treatment we can offer them&#44; but the quality of life they achieve in the long term and the rehabilitation of many of them is still insufficient&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusions</span><p id="par0240" class="elsevierStylePara elsevierViewall">Kidney transplant patients are chronically ill&#46;</p><p id="par0245" class="elsevierStylePara elsevierViewall">Even with the enormous improvement in the survival of pediatric kidney transplant patients during childhood and their grafts&#44; and the good adaptation of some of them to their disease&#44; many others have serious difficulties in achieving good social development and independence&#46; More funds and social support are needed to ensure that they have greater support from therapeutic teams -both themselves and their families- that include pedagogical counselors&#44; psychologists&#44; and social workers&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Testimonials</span><p id="par0250" class="elsevierStylePara elsevierViewall">&#8226; I have received your letter&#44; it gave me great joy&#46; I&#39;m already 45 years old&#46; I started my illness at the age of 11&#46; My first transplant lasted 11 and a half years&#46; Five years after the intervention I had a rejection&#44; but the kidney lasted 6 and a half more years&#46; I went back on dialysis during 1 year and 4 months&#44; and I was transplanted again 18 years ago&#44; and everything was perfect thanks to my donor&#46; I got married&#44; I did not have children&#44; I completed basic school and courses in sewing and hairdressing&#46; I live with my mother and my husband&#46; The truth is&#44; I don&#39;t do much sport because I wear hip prostheses&#44; and previously I had another on my femur&#46; I don&#39;t have any food problems&#46; Although my family is short&#44; I am the shortest and I am self-conscious about my body&#59; my illness has influenced me a lot&#46; My life has been difficult&#46;</p><p id="par0255" class="elsevierStylePara elsevierViewall">When this confinement thing ends&#44; I&#39;ll go to the hospital&#46; I want to visit my doctors and nurses from my childhood&#46; A million thanks for sending me this letter&#44; it has made me super happy today&#46;</p><p id="par0260" class="elsevierStylePara elsevierViewall">&#8226; What a joy to receive these types of letters&#46; Of course I remember all of you&#46; I hope you are all doing very well&#44; and now more so&#44; with everything we are experiencing&#46;</p><p id="par0265" class="elsevierStylePara elsevierViewall">I&#39;m great&#44; in November I&#39;ll have been transplanted for 13 years&#46; I have myomas in the uterus&#44; but it is something that does not worry me at the moment&#44; and with the checkups they always have me under control&#46; At the end of 2018 I was very ill&#44; with a <span class="elsevierStyleItalic">Clostridium</span> infection&#44; what a cursed time&#8230; there were bad months&#44; my lab values were out of control with the bacteria until the end of 2019&#44; but I&#8217;m here&#44; still in the fight&#44; and still have a way to go&#46; I think that my very positive character makes me take things differently&#46;</p><p id="par0270" class="elsevierStylePara elsevierViewall">In December of last year I finished studying dental prosthesis&#44; and I continue training and studying&#59; in 2010 I became a pharmacy technician&#44; but I am still looking for work&#44; things are very tough&#46; I still live with my parents&#46;</p><p id="par0275" class="elsevierStylePara elsevierViewall">I am happy&#44; I live a life totally like a healthy person with two kidneys&#44; and I even think that I am even doing better than some other people&#44; I take a lot of care of myself&#46; I do a lot of sport&#44; because I feel very good about myself&#44; and my partner&#44; apart from his work&#44; is dedicated to fitness&#44; and you can imagine&#46; With food I take good care of myself and I don&#39;t usually go overboard&#46; Whenever I go to check-ups&#44; people ask me if I am the transplant recipient&#44; because nothing is noticeable to me&#44; and it is true that other patients do not have the quality of life that I have due to many factors&#46;</p><p id="par0280" class="elsevierStylePara elsevierViewall">My physical development is not something I&#39;ve ever worried about&#59; I&#39;m short but&#44; hey&#44; nothing that a pair of good heels can&#8217;t fix&#46;</p><p id="par0285" class="elsevierStylePara elsevierViewall">And that&#8217;s all&#44; I encourage the little ones you have there or the teenagers to try to live a happy and &#8220;normal&#8221; life within their possibilities&#44; encourage them to study and train&#46; Things are bad&#44; but anything could happen in this life and change you overnight&#46; Above all&#44; as I said before&#44; be very positive&#46;</p><p id="par0290" class="elsevierStylePara elsevierViewall">Please keep in touch&#46; A very big hug for the whole team and thank you always&#46;</p><p id="par0295" class="elsevierStylePara elsevierViewall">&#8226;&#8230; I am currently well&#44; thank God and my kidney is working perfectly&#46; I walk for an hour every day&#46; I stopped studying&#44; I didn&#39;t finish the intermediate grades &#40;ESO&#41;&#44; and now I&#39;m studying to try to finish it&#46; I also work on whatever comes up&#46;</p><p id="par0300" class="elsevierStylePara elsevierViewall">My transition to the adult hospital was very good&#44; although it took me a while to adapt to the change&#46;</p><p id="par0305" class="elsevierStylePara elsevierViewall">Personally&#44; I live with my partner in his home and town&#59; he takes very good care of me&#46; At the moment&#44; we have no children&#46;</p><p id="par0310" class="elsevierStylePara elsevierViewall">As soon as things get better&#44; I&#39;ll stop by to say hello&#44; as that hospital was my home for many years&#46; Virtual kisses&#46;</p><p id="par0315" class="elsevierStylePara elsevierViewall">&#8226;&#8230; I am the mother of &#8230;&#44; I am writing these lines to tell you that he is fine&#44; very tired of being on dialysis again&#44; but it seems that that is what we have to face&#46; He has many antibodies and they cannot find a kidney for him&#46;</p><p id="par0320" class="elsevierStylePara elsevierViewall">His life is not too good&#44; because he has been on dialysis for 13 years&#44; so he does not work&#44; he lives with us&#44; now he exercises a lot&#44; he is in the gym and he goes for walks&#46; He had a friend&#44; but she was on dialysis like him and one day she passed away&#46; His studies are just as bad&#44; he has not even obtained his driver&#39;s license&#46; As far as diet&#44; he eats now more or less what he used to eat&#46;</p><p id="par0325" class="elsevierStylePara elsevierViewall">Now they say that he has it very difficult and we don&#39;t know what to do&#44; he comes super tired&#44; with the spirit that characterizes him&#44; and I see him some days and I don&#39;t know what to think&#46;</p><p id="par0330" class="elsevierStylePara elsevierViewall">You don&#39;t know how grateful I am for your letter&#8230;</p><p id="par0335" class="elsevierStylePara elsevierViewall">&#8226; &#8230; In December&#44; 32 years ago&#44; I had a kidney transplant and I&#39;m still fine&#46; I didn&#39;t get to study anything serious&#44; I work as a housewife&#46; I spent a few years working in a hotel&#46; I got married 21 years ago&#44; and I have a 15-year-old son&#59; it was a great pregnancy&#44; and then I had a couple of miscarriages&#46; I live at home with my husband and son&#44; within my limitations I live happily&#44; and my life does not change much from that of others&#46; My physical development has been normal&#44; although it caught me in full growth development&#46; I don&#39;t do any sports&#44; although I walk&#46; My diet is normal&#44; I eat everything&#44; yes&#44; with low amounts of salt&#59; I have high blood pressure due to the narrowing of the kidney vein that was transplanted to me&#44; so I have had several dilations&#59; in the last one they put in a coil&#46;</p><p id="par0340" class="elsevierStylePara elsevierViewall">&#8226; &#8230; I have been transplanted for 26 years&#46; I suffered a lot of bullying because of my appearance both by classmates and teachers&#44; I never wanted to go to school or high school because of that&#46; I could not finish my studies&#44; and in my adult life I still carry those mental problems from my childhood&#46; I only got to third-year of ESO&#46; So my studies are basic&#46; I took a course to be a kindergarten and playroom assistant &#40;because I love children&#41;&#46; I took three months of practical training and I spent the whole time from virus to virus&#44; and I had to leave it&#46;</p><p id="par0345" class="elsevierStylePara elsevierViewall">I took a makeup course and I&#39;m currently doing that for a living&#46;</p><p id="par0350" class="elsevierStylePara elsevierViewall">I have had a stable partner for 10 years&#59; I do not have children&#44; but I would love it&#44; it would be a dream for me&#46;</p><p id="par0355" class="elsevierStylePara elsevierViewall">I live with my parents&#44; but I spend several days with my partner&#46;</p><p id="par0360" class="elsevierStylePara elsevierViewall">&#8226;&#8230; When my son&#44; after the transplant and his recovery at home&#44; returned to his elementary studies&#44; it was not as we would have liked it as parents&#44; and it is not because he suffered some kind of rejection or misunderstanding from his classmates&#44; at all&#44; it was because he felt bad because his classmates had moved on and he looked a lot &#8220;older&#8221; with the new classmates&#46; So we went through a bad times that ended with dropping out of school&#46;</p><p id="par0365" class="elsevierStylePara elsevierViewall">It was a stage of adaptation for everyone to the new situation&#44; for him and for us&#44; wanting to do the best for him and not knowing what was best&#46;</p><p id="par0370" class="elsevierStylePara elsevierViewall">&#8226; I tell you about my experience in the children&#39;s unit of the Virgen del Roc&#237;o&#58; until I reached adolescence I did not realize my situation&#44; although as a child they always explained everything to me very well and I did not have any &#8220;trauma&#8221;&#59; on the contrary&#44; whenever I remember something they are good memories&#44; but I think that the boys and girls who are entering adolescence should have a psychologist&#44; and with the new technologies so many trips and visits to the hospital should be avoided&#46;</p><p id="par0375" class="elsevierStylePara elsevierViewall">Regarding my studies&#44; I had some problems in school but I managed to complete my intermediate school &#40;ESO&#41; and a more advanced course in marketing&#44; business&#44; and e-commerce&#46; Currently I am not working because I am back on dialysis&#44; but I want to finish the course internship and get to work&#46;</p><p id="par0380" class="elsevierStylePara elsevierViewall">Fortunately&#44; I met a wonderful girl 4 years ago with whom I am very happy&#44; who supports me and understands me&#46;</p><p id="par0385" class="elsevierStylePara elsevierViewall">I still live with my parents&#44; because I don&#39;t have a job&#44; but I would like to become independent soon&#46;</p><p id="par0390" class="elsevierStylePara elsevierViewall">The truth is that I am happy with my life&#44; although it differs a lot from that of my friends&#44; who&#44; at my same age&#44; have their jobs and their lives are very different&#46;</p><p id="par0395" class="elsevierStylePara elsevierViewall">I don&#39;t usually do much sport&#44; I&#39;ve always been a very sedentary boy&#44; but it doesn&#39;t stop me from taking care of my diet and I always try to control my weight&#46;</p><p id="par0400" class="elsevierStylePara elsevierViewall">The eating habits on dialysis are much stricter&#44; both because of the food and the drink&#44; and I have to control myself much more so as not to carry too much weight on the days of dialysis&#44; and there are foods that I cannot take&#46;</p><p id="par0405" class="elsevierStylePara elsevierViewall">The kidney issue has influenced my development&#58; I could have been somewhat taller&#46;</p><p id="par0410" class="elsevierStylePara elsevierViewall">&#8226; &#8230; Regarding my personal life&#44; I am still at my parents&#39; house&#44; without a partner and I obtained my school certificate a year ago at adult school&#44; but starting with COVID my life stagnated again&#46; My physical development has been adequate with respect to my family&#44; in size and weight&#46; But my life&#44; compared to that of people my age&#44; is very different&#44; I do not carry out the activities that a person of my age could do&#59; the whole problem has affected my personal life&#44; but I try to carry on as well as I can&#8230;</p><p id="par0415" class="elsevierStylePara elsevierViewall">&#8226; Since you transferred me to adult clinic&#44; everything about the kidney is very good so far&#44; and God-willing it will continues this way&#44; I am very responsible with my treatment&#46; I still hear badly&#46;</p><p id="par0420" class="elsevierStylePara elsevierViewall">After 5 years of transplantation&#44; in 2009&#44; I was diagnosed with a bulb cavernoma due to bleeding in the brain&#59; I was very ill and half my body was paralyzed&#44; I did not see well&#44; I had double vision&#46; After a year it happened again&#44; in the area where it was they could not operate&#44; and I spent two years until I recovered&#46;</p><p id="par0425" class="elsevierStylePara elsevierViewall">Thank God the cavernoma was absorbed slowly&#44; and since then I have been followed up every year and have an MRI&#46; The secuela that has stuck with me is that if I look sideways I see double&#59; otherwise everything is fine&#44; despite the fact that I had a very bad time&#46;</p><p id="par0430" class="elsevierStylePara elsevierViewall">About studies&#44; I missed many classes and courses&#44; I did not make enough progress&#44; it was very difficult for me to memorize and study&#44; with the problem of hearing it is very difficult for me to grasp and understand things&#46; I got my ESO certificate with a lot of effort and help from my mother and teachers&#46; When I recovered from the paralysis&#44; I got my driver&#39;s license&#44; which also was difficult and it took a lot of effort&#46;</p><p id="par0435" class="elsevierStylePara elsevierViewall">As for work&#44; I dedicated myself to going with my father to fix gardens and swimming pools&#44; and I&#39;m still with him&#46;</p><p id="par0440" class="elsevierStylePara elsevierViewall">I don&#39;t currently have a partner or children&#59; I had two partners&#44; but it didn&#39;t go well&#46; I live with my parents and I have never been independent&#46;</p><p id="par0445" class="elsevierStylePara elsevierViewall">I am happy&#44; I get along very well with my parents&#44; my sister and my friends&#44; but my friends&#44; unlike me&#44; perform much better in all aspects of life&#46; Sometimes I ride my bike or play football&#46; I have no eating problems and I like all kinds of food&#46; My physical development has not been the one that would correspond to me in size or weight&#46;</p><p id="par0450" class="elsevierStylePara elsevierViewall">I would consider that it would be very good if there were psychologists in hospitals&#44; since it is very hard to live this situation and spend so many years in the hospital or visiting hospitals&#44; since I have not stopped since birth&#46; This whole situation&#44; everything I have experienced&#44; has created dependence on my parents and I am not able to take care of myself independently&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Funding</span><p id="par0455" class="elsevierStylePara elsevierViewall">This work has not received any grants or scholarships from public or commercial agencies or non-profit entities&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflict of interests</span><p id="par0460" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare&#46;</p></span></span>"
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            1 => "Paediatric"
            2 => "Life expectancy"
            3 => "Quality of life"
            4 => "Life post-transplant"
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            0 => "Trasplante renal"
            1 => "Pedi&#225;trico"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction and objectives</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">There is currently no doubt that a kidney transplant with good function is the best treatment we can offer a child with severe kidney failure&#44; improving their growth&#44; development and life in general&#46; But there are few works that follow these patients over the years to find out what their life is like as adults&#44; their achievements and if there are any difficulties that may have arisen from their illness&#46; That has been the objective of this work&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">We have collected the evolution of 287 patients who received at least one kidney transplant in pediatric age&#44; analyzing not only the survival of grafts and recipients but&#44; fundamentally&#44; their current quality of life&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Over a 40-year period &#40;1979&#8722;2019&#41;&#44; 345 kidney transplants were performed in 287 pediatric recipients&#44; with a rate of retransplantation before reaching the age of majority of 16&#46;7&#37;&#46; Survival&#44; both of patients and grafts&#44; has improved remarkably in the last 20 years&#46; The survival of transplanted patients in the period from 1979 to 1996 at 10&#44; 20 and 25 years after the intervention was 83&#37;&#44; 76&#37; and 65&#37; respectively&#44; and 94&#37; and 82&#37; at 10 and 20 years respectively in those transplanted in the period from 1997 to 2019&#46; Graft survival in the period from 1979 to 1996 at 10 and 20 years was 39&#37; and 18&#37;&#44; increasing in the second period to 68&#37; and 34&#37; respectively&#46; Survival of the first living donor graft &#40;LD&#41; at 5 and 10 years was 94&#37; and 89&#37;&#46; Currently 150 of these patients are adults&#46; Of these&#44; 32&#37; have a stable partner and 6&#46;6&#37; have children&#46; The level of training is lower than that of the general population and many of them have other comorbidities&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">The life expectancy of pediatric patients with kidney failure transplanted during childhood has improved markedly in recent decades&#44; as has graft survival&#44; being better with a living donor&#46; In general&#44; they consider themselves satisfied with their lives&#44; with great acceptance of their illness and limitations&#44; but -analyzing their testimonies- we conclude that they lack social support&#44; both for themselves and their families&#44; to achieve a higher level of education and better quality of life&#46;</p></span>"
        "secciones" => array:4 [
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            "titulo" => "Introduction and objectives"
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          1 => array:2 [
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n y objetivos</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Actualmente no hay duda de que un trasplante renal con buena funci&#243;n es el mejor tratamiento que podemos ofrecer a un ni&#241;o con insuficiencia renal severa&#44; mejorando su crecimiento&#44; desarrollo y actividad en general&#46; Pero hay pocos trabajos que sigan a estos pacientes a lo largo de los a&#241;os para conocer c&#243;mo es su vida de adultos&#44; sus logros y si hay dificultades que han podido derivarse de su enfermedad&#46; Ese ha sido el objetivo de este trabajo&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Hemos recogido la evoluci&#243;n de 287 pacientes que recibieron al menos un trasplante renal en edad pedi&#225;trica en nuestra unidad&#44; analizando no solo la supervivencia de los injertos y receptores sino&#44; fundamentalmente&#44; su calidad de vida actual&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">En un periodo de 40 a&#241;os &#40;1979&#8722;2019&#41; se realizaron 345 trasplantes renales en 287 receptores pedi&#225;tricos&#44; con una tasa de retrasplantes antes de cumplir la mayor&#237;a de edad del 16&#44;7&#37;&#46; La supervivencia&#44; tanto de los pacientes como de los injertos&#44; ha mejorado notablemente en los &#250;ltimos 20 a&#241;os&#46; La supervivencia de los pacientes trasplantados en el periodo de 1979 a 1996 a los 10&#44; 20 y 25 a&#241;os de la intervenci&#243;n fue del 83&#37;&#44; 76&#37; y 65&#37; respectivamente&#44; y del 94&#37; y 82&#37; a los 10 y 20 a&#241;os respectivamente en los trasplantados en el periodo de 1997 a 2019&#46; La supervivencia del injerto en el periodo de 1979 a 1996 a los 10 y 20 a&#241;os fue del 39&#37; y 18&#37;&#44; aumentando en el segundo periodo al 68&#37; y 34&#37; respectivamente&#46; La supervivencia del primer injerto con donante vivo &#40;DV&#41; a los 5 y 10 a&#241;os fue del 94&#37; y 89&#37;&#46;</p><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Actualmente son adultos 150 de estos pacientes&#46; De ellos&#44; 32&#37; tienen pareja estable y 6&#44;6&#37; tienen hijos&#46; El nivel de formaci&#243;n es menor que el de la poblaci&#243;n general y muchos de ellos tienen otras comorbilidades&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">La esperanza de vida de los pacientes pedi&#225;tricos con insuficiencia renal trasplantados durante la infancia ha mejorado notablemente en las &#250;ltimas d&#233;cadas&#44; as&#237; como la supervivencia de los injertos&#44; siendo mejor con donante vivo&#46; En general&#44; ellos se consideran satisfechos con su vida&#44; con gran aceptaci&#243;n de su enfermedad y limitaciones&#44; pero -analizando sus testimonios- concluimos que les falta apoyo social&#44; tanto a ellos como a sus familias&#44; para lograr un nivel educativo m&#225;s alto y mejor calidad de vida&#46;</p></span>"
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                  \t\t\t\t">Education &#47; Training&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Children&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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">Independent &#47; family housing&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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">Sport &#47; physical activity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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">Feeding&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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">Physical development&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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">Other free comments&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><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"><span class="elsevierStyleItalic">Sex&#44; n &#40;&#37;&#41;</span>&nbsp;\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">V 172 &#40;60&#41; &#47; M 115 &#40;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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"><span class="elsevierStyleItalic">Average age &#40;years&#41;</span>&nbsp;\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">10&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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 colgroup " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Age groups &#40;years&#41;</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"><span class="elsevierStyleHsp" style=""></span>&#60;5&nbsp;\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">55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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"><span class="elsevierStyleHsp" style=""></span>5 a &#60;10&nbsp;\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">89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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"><span class="elsevierStyleHsp" style=""></span>10 a &#60;15&nbsp;\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">156&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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"><span class="elsevierStyleHsp" style=""></span>15 a &#8804;18&nbsp;\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">45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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"><span class="elsevierStyleItalic">Weight&#160;&#60;&#160;15&#160;kg&#44; n &#40;&#37;&#41;</span>&nbsp;\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">55 &#40;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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_colgroup " colspan="2" 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 colgroup " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Etiology IRT&#44; n &#40;&#37;&#41;</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"><span class="elsevierStyleHsp" style=""></span>Structural anomalies&nbsp;\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">105 &#40;36&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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"><span class="elsevierStyleHsp" style=""></span>Congenital &#47; hereditary diseases&#46;&nbsp;\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">64 &#40;22&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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"><span class="elsevierStyleHsp" style=""></span>Glomerulopathies&#46;&nbsp;\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">62 &#40;21&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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"><span class="elsevierStyleHsp" style=""></span>Vascular&nbsp;\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">28 &#40;9&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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"><span class="elsevierStyleHsp" style=""></span>First transplant&#46;&nbsp;\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">287&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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"><span class="elsevierStyleHsp" style=""></span>Retransplant&nbsp;\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">58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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_colgroup " colspan="2" 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 colgroup " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Dialysis &#40;D&#41; preTx&#44; n &#40;&#37;&#41;</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"><span class="elsevierStyleHsp" style=""></span>D&#46; peritoneal&#46;&nbsp;\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">129 &#40;37&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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"><span class="elsevierStyleHsp" style=""></span>Hemodialysis&nbsp;\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">146 &#40;42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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"><span class="elsevierStyleHsp" style=""></span>D&#46; peritoneal &#47; HD&#46;&nbsp;\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">7 &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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"><span class="elsevierStyleHsp" style=""></span>Predialysis&nbsp;\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">63 &#40;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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"><span class="elsevierStyleHsp" style=""></span>Average time on dialysis &#40;months&#41;&#46;&nbsp;\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">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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"><span class="elsevierStyleHsp" style=""></span>Donor type &#40;D&#41;&#44; n &#40;&#37;&#41;&#59; cadaver &#40;C&#41; &#47; living &#40;V&#41;&#46;&nbsp;\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">DC 302 &#40;87&#46;5&#41;&#59; DV 43 &#40;12&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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_colgroup " colspan="2" 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 colgroup " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Immunosuppression&#44; n &#40;&#37;&#41;</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"><span class="elsevierStyleHsp" style=""></span>Cyclosporine &#47; tacrolimus&#46;&nbsp;\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">119 &#40;34&#41; &#47; 223 &#40;65&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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"><span class="elsevierStyleHsp" style=""></span>Azathioprine &#47; MMF&#46;&nbsp;\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">90 &#40;26&#41; &#47; 253 &#40;73&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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"><span class="elsevierStyleHsp" style=""></span>Prednisone&nbsp;\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">345 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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"><span class="elsevierStyleHsp" style=""></span>IL-2 receptor&#46;O&nbsp;\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">251 &#40;73&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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"><span class="elsevierStyleHsp" style=""></span>Thymoglobulin &#47; OKT3&#46;&nbsp;\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">58 &#40;17&#41; &#47; 5&#40;1&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab3383537.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Patient characteristics &#40;n&#160;&#61;&#160;287&#41;&#46;</p>"
        ]
      ]
      5 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
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        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0030"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
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            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">&nbsp;\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">n&nbsp;\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">Infectious&nbsp;\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">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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">Cerebral vascular accident&nbsp;\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">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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">Acute hemorrhage&nbsp;\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">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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">Cardiac pathology&nbsp;\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">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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">Tumor&nbsp;\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">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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">Generalized oxalosis&nbsp;\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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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">Respiratory&nbsp;\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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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">Extreme cachexia&nbsp;\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">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                0 => "xTab3383538.png"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Causes of death&#46;</p>"
        ]
      ]
      6 => array:8 [
        "identificador" => "tbl0020"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0035"
            "detalle" => "Table "
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        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Units&#58; years&#46;</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Source&#58; Mortality tables&#44; INE&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Available at&#58; <span class="elsevierStyleInterRef" id="intr0005" href="https://www.ine.es/jaxi/Datos.htm?path=/t00/mujeres_hombres/tablas_1/l0/&amp;file=d01005.px">https&#58;&#47;&#47;www&#46;ine&#46;es&#47;jaxi&#47;Datos&#46;htm&#63;path&#61;&#47;t00&#47;mujeres&#95;hombres&#47;tablas&#95;1&#47;l0&#47;&#38;file&#61;d01005&#46;px</span>&#46;</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="\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">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2019</th><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2009</th></tr><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">&nbsp;\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">Men&nbsp;\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">Women&nbsp;\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">Gender gap &#40;women-men&#41;&nbsp;\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">Men&nbsp;\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">Women&nbsp;\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">Gender gap &#40;women-men&#41;&nbsp;\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">At birth&nbsp;\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">80&#46;9&nbsp;\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">86&#46;2&nbsp;\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">5&#46;4&nbsp;\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">78&#46;6&nbsp;\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">84&#46;7&nbsp;\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">6&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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">10 years&nbsp;\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">71&#46;2&nbsp;\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">76&#46;5&nbsp;\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">5&#46;3&nbsp;\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">69&#46;0&nbsp;\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">75&#46;0&nbsp;\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">6&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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">20 years&nbsp;\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">61&#46;3&nbsp;\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">66&#46;6&nbsp;\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">5&#46;3&nbsp;\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">59&#46;1&nbsp;\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">65&#46;1&nbsp;\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">5&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab3383534.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Life expectancy at different ages by period&#46; Gender gap&#46; Spain&#46;</p>"
        ]
      ]
      7 => array:8 [
        "identificador" => "tbl0025"
        "etiqueta" => "Table 5"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0040"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\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">&nbsp;\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">Number of patients &#47; Period&nbsp;\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">10 years&nbsp;\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">20 years&nbsp;\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">Davidovits M&#46;&#44; Pediatr Nephrol&#44; 2021&#44; Israel&nbsp;\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">545 &#40;1981&#8722;2017&#41;&nbsp;\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">DV&#58; 94&#46;8&#59; DC&#58; 89&#46;9&nbsp;\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">DV&#58; 91&#46;4&#59; DC&#58; 80&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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">Mumford L&#46;&#44; Transpl Int&#44; 2019&#44; United Kingdom&#46;&nbsp;\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&#46;912 &#40;1987&#8722;2016&#41;&nbsp;\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">93&nbsp;\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">84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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">Sypek M&#46;P&#46;&#44; Pediatr Transpl&#44; 2021&#44; Australia&nbsp;\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">1989&#8722;1998&nbsp;\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">81&nbsp;\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">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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">&nbsp;\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">1999&#8722;2008&nbsp;\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">89&nbsp;\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">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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">&nbsp;\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">2009&#8722;2018&nbsp;\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">98&nbsp;\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">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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">Cordinh&#224; C&#46;&#44; Transplant Proc&#44; 2019&#44; Coimbra&nbsp;\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">104 &#40;1981&#8722;2016&#41;&nbsp;\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">92&#46;7&nbsp;\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">85&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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">Fijo J&#46;&#44; Andalusia&nbsp;\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">287 &#40;1979&#8722;2019&#41;&nbsp;\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">1979&#8722;1996&#58; 83&nbsp;\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">1979&#8722;1996&#58; 76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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">&nbsp;\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">&nbsp;\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">1997&#8722;2019&#58; 94&nbsp;\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">1997&#8722;2019&#58; 82&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3383536.png"
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Patient survival &#40;&#37;&#41;&#46;</p>"
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      ]
      8 => array:8 [
        "identificador" => "tbl0030"
        "etiqueta" => "Table 6"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0045"
            "detalle" => "Table "
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        "tabla" => array:1 [
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            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">&nbsp;\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">Number of transplants&#47;Period&nbsp;\t\t\t\t\t\t\n
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                  \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">5 years&nbsp;\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">10 years&nbsp;\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">20 years&nbsp;\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">Davidovits M&#46;&#44; Pediatr Nephrol&#44; 2021&#44; Israel<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&nbsp;\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">599 &#40;1981&#8722;2017&#41;&nbsp;\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">DV&#58; 87&#46;9&nbsp;\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">75&#46;2&nbsp;\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">47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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">&nbsp;\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">&nbsp;\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">DC&#58; 77&nbsp;\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">60&#46;7&nbsp;\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">38&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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">Mumford L&#46;&#44; Transpl Int&#44; 2019&#44; United Kingdom&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&nbsp;\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">3&#46;236 &#40;1987&#8722;2016&#41;&nbsp;\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">All&#58; 79&nbsp;\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">65&nbsp;\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">42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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">&nbsp;\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">&nbsp;\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">DV&#58; 89&nbsp;\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">74&nbsp;\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">49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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">&nbsp;\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">&nbsp;\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">DC&#58; 75&nbsp;\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">61&nbsp;\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">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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">Sypek M&#46;P&#46;&#44; Pediatr Transpl&#44; 2021&#44; Australia<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&nbsp;\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">426 &#40;1989&#8722;2018&#41;&nbsp;\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">&nbsp;\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">&nbsp;\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">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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">&nbsp;\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">&#40;1999&#8722;2008&#41;&nbsp;\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">65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">49&nbsp;\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">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#40;2009&#8722;2018&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">70&nbsp;\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
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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
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                  \t\t\t\t">Cordinh&#224; C&#46;&#44; Transplant Proc&#44; 2019&#44; Coimbra<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&nbsp;\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
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                  \t\t\t\t">111 &#40;1981&#8722;2016&#41;&nbsp;\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
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                  \t\t\t\t">79&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">74&#46;3&nbsp;\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
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                  \t\t\t\t">52&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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">NAPRTCS&#44; 2018&#44; USA&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&nbsp;\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
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                  \t\t\t\t">428 &#40;2012&#8722;2017&#41;&nbsp;\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">DV&#58; 94&#46;9&nbsp;\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">&nbsp;\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
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&nbsp;\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">DC&#58; 90&#46;1&nbsp;\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">&nbsp;\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
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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">Fijo J&#46;&#44; Andalusia&nbsp;\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
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                  \t\t\t\t">345 &#40;DC&#160;&#43;&#160;DV&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1979&#8722;1996 60&nbsp;\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
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&#40;1979&#8722;2019&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1997&#8722;2019 80&nbsp;\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">68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">DV&#58; &#40;2005&#8722;2019&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">94&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pediatric kidney transplantation&#58; experience of a center over 4 decades"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Cordinh&#224;"
                            1 => "L&#46; Rodrigues"
                            2 => "C&#46; Carmo"
                            3 => "C&#46; Gomes"
                            4 => "F&#46; Mac&#225;rio"
                            5 => "A&#46;J&#46; Correia"
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                      "doi" => "10.1016/j.transproceed.2019.05.007"
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                        "tituloSerie" => "Transplant Proc&#46;"
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                        "volumen" => "51"
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                  "referenciaCompleta" => "Instituto Nacional de Estad&#237;stica&#46; Mortalidad&#46; Indicadores de Mortalidad&#46; Available from&#58; <a target="_blank" href="https://www.ine.es/dynt3/inebase/index.htm?padre=1153&amp;capsel=2062">https&#58;&#47;&#47;www&#46;ine&#46;es&#47;dynt3&#47;inebase&#47;index&#46;htm&#63;padre&#61;1153&#8745;sel&#61;2062</a>&#46;"
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                  "contribucion" => array:1 [
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                      "titulo" => "The European Renal Association-European Dialysis and Transplant Association &#40;ERA-EDTA&#41; Registry Annual Report 210&#58; a summary"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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                            1 => "M&#46; Pippias"
                            2 => "M&#46; Noordzij"
                            3 => "V&#46;S&#46; Stel"
                            4 => "A&#46;M&#46; Andrusev"
                            5 => "M&#46;I&#46; Aparicio-Madre"
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                      "titulo" => "The impact of changing practice on improved outcomes of paediatric renal transplantation in the United Kingdom&#58; a 25 years review"
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                          "etal" => false
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                            1 => "H&#46; Maxwell"
                            2 => "N&#46; Ahmad"
                            3 => "S&#46;D&#46; Marks"
                            4 => "J&#46; Tizard"
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                      "doi" => "10.1111/tri.13418"
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                        "fecha" => "2019"
                        "volumen" => "32"
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                          "etal" => true
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                            2 => "R&#46; Cleper"
                            3 => "N&#46; Bar-Nathan"
                            4 => "I&#46; Krause"
                            5 => "A&#46; Dagan"
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                          "etal" => true
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                            2 => "A&#46;K&#46; Le Page"
                            3 => "P&#46; Clayton"
                            4 => "P&#46;D&#46; Hughes"
                            5 => "N&#46; Larkins"
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                      "titulo" => "on behalf of the NAPRTCS investigators&#46; Kidney transplant practice patterns and outcome benchmarks over 30 years&#58; The 2018 report of the NAPRTCS"
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                          "etal" => true
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                            1 => "C&#46; Cramer"
                            2 => "A&#46; Moudgil"
                            3 => "K&#46; Martz"
                            4 => "J&#46; Smith"
                            5 => "T&#46; Blydt-Hansen"
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                      "autores" => array:1 [
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                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46;J&#46; Van Arendonk"
                            1 => "J&#46;M&#46; Garonzik Wang"
                            2 => "N&#46;A&#46; Deshpande"
                            3 => "N&#46;T&#46; James"
                            4 => "J&#46;M&#46; Smith"
                            5 => "R&#46;A&#46; Montgomery"
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        "texto" => "<p id="par0465" class="elsevierStylePara elsevierViewall">We thank all our patients for the affection they have transmitted to us in all their answers&#44; for having collaborated with us by telling us about their experience and their life&#44; and what they have taught us with their attitude in the face of all their adversities&#46;</p>"
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ISSN: 20132514
Original language: English
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