array:21 [
  "pii" => "X2013251409003711"
  "issn" => "20132514"
  "doi" => "10.3265/Nefrologia.2009.29.5.5413.en.full"
  "estado" => "S300"
  "fechaPublicacion" => "2009-10-01"
  "documento" => "article"
  "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
  "subdocumento" => "fla"
  "cita" => "Nefrologia (English Version). 2009;29:474-8"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 4663
    "formatos" => array:3 [
      "EPUB" => 275
      "HTML" => 3834
      "PDF" => 554
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:17 [
      "pii" => "X0211699509003714"
      "issn" => "02116995"
      "doi" => "10.3265/Nefrologia.2009.29.5.5413.en.full"
      "estado" => "S300"
      "fechaPublicacion" => "2009-10-01"
      "documento" => "article"
      "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
      "subdocumento" => "fla"
      "cita" => "Nefrologia. 2009;29:474-8"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 9942
        "formatos" => array:3 [
          "EPUB" => 260
          "HTML" => 9113
          "PDF" => 569
        ]
      ]
      "es" => array:11 [
        "idiomaDefecto" => true
        "titulo" => "Efecto del micofenolato de mofetilo y azatioprina sobre la hiperplasia gingival asociada al uso de ciclosporina A en pacientes con trasplante renal"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "474"
            "paginaFinal" => "478"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "The effect of mycophenolate mophetil and azathioprine on gingival overgrowth associated with cyclosporin A use in kidney transplant patients"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "E. de la Rosa García, A. Mondragón Padilla"
            "autores" => array:2 [
              0 => array:2 [
                "Iniciales" => "E."
                "apellidos" => "de la Rosa García"
              ]
              1 => array:2 [
                "Iniciales" => "A."
                "apellidos" => "Mondragón Padilla"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "X2013251409003711"
          "doi" => "10.3265/Nefrologia.2009.29.5.5413.en.full"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251409003711?idApp=UINPBA000064"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699509003714?idApp=UINPBA000064"
      "url" => "/02116995/0000002900000005/v0_201502091404/X0211699509003714/v0_201502091405/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:17 [
    "pii" => "X2013251409003887"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.2009.29.5.5324.en.full"
    "estado" => "S300"
    "fechaPublicacion" => "2009-10-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia (English Version). 2009;29:479-81"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 5014
      "formatos" => array:3 [
        "EPUB" => 223
        "HTML" => 3997
        "PDF" => 794
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "titulo" => "Coeliac disease and membranous nephropathy"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "479"
          "paginaFinal" => "481"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Enfermedad celíaca y nefropatía membranosa"
        ]
      ]
      "contieneResumen" => array:2 [
        "es" => true
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig1"
          "etiqueta" => "Fig. 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "copyright" => "Elsevier España"
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "41918078_f1_pag480.jpg"
              "Alto" => 320
              "Ancho" => 398
              "Tamanyo" => 15886
            ]
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "S. Soro, M.D. Sánchez de la Nieta, F. Rivera"
          "autores" => array:3 [
            0 => array:2 [
              "Iniciales" => "S."
              "apellidos" => "Soro"
            ]
            1 => array:2 [
              "Iniciales" => "M.D."
              "apellidos" => "Sánchez de la Nieta"
            ]
            2 => array:2 [
              "Iniciales" => "F."
              "apellidos" => "Rivera"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X021169950900388X"
        "doi" => "10.3265/Nefrologia.2009.29.5.5324.en.full"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X021169950900388X?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251409003887?idApp=UINPBA000064"
    "url" => "/20132514/0000002900000005/v0_201502091625/X2013251409003887/v0_201502091626/en/main.assets"
  ]
  "itemAnterior" => array:17 [
    "pii" => "X2013251409003621"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.2009.29.5.5493.en.full"
    "estado" => "S300"
    "fechaPublicacion" => "2009-10-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia (English Version). 2009;29:464-73"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 5791
      "formatos" => array:3 [
        "EPUB" => 264
        "HTML" => 4817
        "PDF" => 710
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "titulo" => "Study of oxidative stress in advanced kidney disease"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "464"
          "paginaFinal" => "473"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Estudio del estrés oxidativo en enfermedad renal avanzada"
        ]
      ]
      "contieneResumen" => array:2 [
        "es" => true
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig1"
          "etiqueta" => "Tab.  1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "copyright" => "Elsevier España"
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "41718078_t1_pag466.jpg"
              "Alto" => 117
              "Ancho" => 828
              "Tamanyo" => 18148
            ]
          ]
          "descripcion" => array:1 [
            "en" => "Characteristics of the groups under study"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "M.J. Puchades Montesa, M.A. González Rico, M.A. Solís Salguero, I. Torregrosa Maicas, I. Juan García, A. Miguel Carrasco, M.C. Tormos Muñoz, G. Sáez Tormo"
          "autores" => array:8 [
            0 => array:2 [
              "Iniciales" => "M.J."
              "apellidos" => "Puchades Montesa"
            ]
            1 => array:2 [
              "Iniciales" => "M.A."
              "apellidos" => "González Rico"
            ]
            2 => array:2 [
              "Iniciales" => "M.A."
              "apellidos" => "Solís Salguero"
            ]
            3 => array:2 [
              "Iniciales" => "I."
              "apellidos" => "Torregrosa Maicas"
            ]
            4 => array:2 [
              "Iniciales" => "I."
              "apellidos" => "Juan García"
            ]
            5 => array:2 [
              "Iniciales" => "A."
              "apellidos" => "Miguel Carrasco"
            ]
            6 => array:2 [
              "Iniciales" => "M.C."
              "apellidos" => "Tormos Muñoz"
            ]
            7 => array:2 [
              "Iniciales" => "G."
              "apellidos" => "Sáez Tormo"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X0211699509003624"
        "doi" => "10.3265/Nefrologia.2009.29.5.5493.en.full"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699509003624?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251409003621?idApp=UINPBA000064"
    "url" => "/20132514/0000002900000005/v0_201502091625/X2013251409003621/v0_201502091626/en/main.assets"
  ]
  "en" => array:15 [
    "idiomaDefecto" => true
    "titulo" => "The effect of mycophenolate mophetil and azathioprine on gingival overgrowth associated with cyclosporin A use in kidney transplant patients"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "474"
        "paginaFinal" => "478"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "E. de la Rosa García, A. Mondragón Padilla"
        "autores" => array:2 [
          0 => array:4 [
            "Iniciales" => "E."
            "apellidos" => "de la Rosa García"
            "email" => array:1 [
              0 => "delarosa0712@msn.com"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          1 => array:3 [
            "Iniciales" => "A."
            "apellidos" => "Mondrag&#243;n Padilla"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:3 [
            "entidad" => "Departamento de Atención a la Salud, Universidad Autónoma Metropolitana Xoch. Servicio de Nefrología, Hospital General de Zona 50, Instituto Mexicano del Seguro Social, San Luis Potosí,  México, "
            "etiqueta" => "<span class="elsevierStyleSup">a</span>"
            "identificador" => "affa"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Efecto del micofenolato de mofetilo y azatioprina sobre la hiperplasia gingival asociada al uso de ciclosporina A en pacientes con trasplante renal"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:8 [
        "identificador" => "fig1"
        "etiqueta" => "Tab.  1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "41818078_t1_pag475.jpg"
            "Alto" => 272
            "Ancho" => 828
            "Tamanyo" => 51997
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Prevalence and severity of gingival overgrowth in groups using Cyclosporin A&#44; Tacrolimus&#44; or neither one"
        ]
      ]
    ]
    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">INTRODUCTION</span></p><p class="elsevierStylePara">The use of cyclosporin A or tacrolimus in kidney transplant patients is frequently accompanied by side effects&#46;<span class="elsevierStyleSup">1</span> Oral Adverse effects are mainly cosmetic&#44; but opportunistic fungal or viral infections may also flare up&#46;<span class="elsevierStyleSup">2&#44;3</span> The most common orallesion is the firm&#44; lobulated enlargement of the gums known as gingival overgrowth &#40;GO&#41; or gingival hyperplasia&#44; with reported prevalence as high as 74&#37;&#44;<span class="elsevierStyleSup">2-4</span> arising as a result of the interplay of several factors&#44; including CyA and calcium channel blocker anti-hypertensive drugs use&#44; gingival inflammation and poor oral higiene&#46;<span class="elsevierStyleSup">4</span> Histologically&#44; GO is marked by fibroblast proliferation&#44; deposition of amorphous extracellular material and mononuclear inflammatory infiltrate&#46;<span class="elsevierStyleSup">5</span> Tac - associated GO prevalence is much lower&#46;<span class="elsevierStyleSup">6</span> There have been only a few literature reports on Sirolimus - associated GO&#46;<span class="elsevierStyleSup">7</span></p><p class="elsevierStylePara">The aims of the study were to assess GO prevalence and severity in a group of KT patients using CyA&#44; Tac or Siro as principal immunosuppressor drugs and to evaluate the effect of the following factors on GO prevalence&#58; use of Aza or MMF as a secondary immunosuppressor drug&#44; calcium channel blocker anti-hypertensive drugs&#44; kidney graft function level&#44; fasting glycemia&#44; oral hygiene and age&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">MATERIAL AND METHODS</span></p><p class="elsevierStylePara">It was a cross &#191; sectional study&#44; carried out in the nephrology service outpatient clinic at HGZ &#35; 50 IMSS&#44; San Luis Potos&#237;&#46; The study was approved by the hospital&#191;s research and ethics committees&#46; All participants were asked for permission to perform an oral examination&#44; which included an evaluation of gingival overgrowth and oral hygiene&#46; Consecutive KT cases attending nephrology consultation follow &#191; up were examined&#46; The total group was split into cases using CyA&#44; Tac or Siro as principal immunosuppresor drug&#46; Demographic and clinical data was gathered from medical records&#44; including cause of end stage renal disease before KT&#44; elapsed time since transplant surgery&#44; CyA&#44; Tac and Siro doses and blood levels&#44; use of MMF or Aza&#44; use of Calcium channel blocker anti-hypertensives&#44; and laboratory results&#46; For GO diagnostic evaluation purposes&#44; the dental arches were divided into sextants &#40;three upper and three lower&#41;&#46; GO severity was classified into four categories using the criteria established by Pernu et al&#46;&#58;<span class="elsevierStyleSup">4</span> score 0&#44; no gingival overgrowth&#59; score 1&#44; slight overgrowth with thickening of marginal gum tissue&#59; score 2&#44; moderate gum overgrowth extending to half of the crown&#44; and score 3&#44; severe overgrowth&#44; covering two thirds of the crown and affecting Inserted gum&#46; Oral hygiene was classified as good&#44; fair&#44; or poor according to the simplified oral hygiene index&#44;8 assessing amount and location of bacterial plaque on tooth crowns&#46; We carried out a descriptive statistical analysis for the following demographic and clinical variables&#58; sex&#44; age&#44; body mass index&#44; cause of end stage renal disease before KT&#44; elapsed time since transplant&#44; medications used and clinical laboratory results&#46; Continuous variables were compared using the Student t-test or ANOVA&#44; and proportions using Chi2&#46; Associations were analysed with Chi2 or multiple logistic regression as applicable&#44; using Excel 2007 and Epi Info version 3&#46;4&#46;3&#46; The multiple logistic regression model included independent variables potentially associated with GO&#44; i&#46;e sex&#44; age&#44; oral hygiene&#44; CyA&#44; Tac or Siro doses and blood levels&#44; secondary immunosuppressor drug and doses&#44; calcium channel blocker anti-hypertensive drugs&#44; elapsed time since kidney transplant and diabetes&#46; Variables with a value p &#62; 0&#46;50 were excluded from subsequent analyses&#46; Values of p &#60; 0&#46;05 were considered statistically significant&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">RESULTS</span></p><p class="elsevierStylePara">The study included 172 kidney transplant patients&#58; 103 men and 69 women&#44; aged 33&#46;0 &#177; 13&#46;7 &#40;9 to 66&#41; years&#59; 48 &#40;27&#46;9&#37;&#41; had a primary-level education or lower&#46; 19 patients &#40;11&#46;2&#37;&#41; were diabetic before KT and nine others &#40;5&#46;3&#37;&#41; had a fasting glycemia &#62; 126mg&#47;dl on lab results closer to oral examination date&#46; Mean elapsed time post &#191; KT was 22 &#40;1&#191;157&#41; months&#46; Ten patients were transplanted three or less months before oral examination&#46; Serum creatinine was 1&#46;4 &#177; 0&#46;4 mg&#47;dl&#44; for an estimated glomerular filtration rate &#40;Levey&#41; of 66 &#177; 28ml&#47;min&#46; The principal immunosuppressor drug was CyA in 137 patients&#44; Tac in 25&#44; Siro in 6 and Aza in 4 &#40;table 1&#41;&#46; The secondary immunosuppressor was Aza in 107 cases&#44; MMF in 56 and Siro in just one patient&#46; Mean CyA and Tac doses were 3&#46;0 and 0&#46;016 mg&#47;kg&#47;day&#44; Siro 2&#46;0 mg&#47;day&#44; MMF 1&#46;25 g&#47;day&#44; Aza 1&#46;4 mg&#47;kg&#47;day and prednisone 0&#46;14 mg&#47;kg&#47;day&#46; Eight cases used CyA &#40;plus prednisone&#41; but not a secondary immunosuppressor&#44; and ten used neither CyA or Tac&#46; GO prevalence with CyA as the principal immunosuppressor was 59&#46;1&#37;&#44; 12&#46;0&#37; with Tac&#44; and 16&#46;7&#37; with Siro&#46; Within the CyA group&#44; GO prevalence was 60&#46;2&#37; for Aza&#44; and 47&#46;2&#37; for MMF subgroups&#44; p&#61;0&#46;18&#44; and 100&#37; in those cases not using a secondary immunosuppressor&#44; p &#61; 0&#44;015 vs&#46; the combined CyA&#43;Aza and CyA&#43;MMF group &#40;Table 1&#41;&#46; There were no differences in the degree of CyA exposure among subgroups using CyA &#43; Aza&#44; CyA &#43; MMF and CyA alone&#44; whether measured by mg&#47;kg&#47;day dosage&#44; with CyA &#43; Aza 3&#46;5 &#177; 1&#46;6&#44; CyA &#43; MMF 3&#46;4 &#177; 1&#46;9 and CyA alone 3&#46;3 &#177; 1&#46;1&#44; p &#62; 0&#46;50&#44; ANOVA&#44; or by C12 CyA blood levels with CyA &#43; Aza 175 &#177; 52&#44; CyA &#43; MMF 174 &#177; 52&#44; and CyA alone 156 &#177; 53 ng&#47;ml&#44; p &#62;0&#44;50&#44; ANOVA&#46; Concerning the effect of other drugs associated with gingival overgrowth&#44; 95 cases used verapamil and 17&#44; nifedipine&#59; out of those groups&#44; 76 and 13 patients&#44; respectively&#44; belonged to the CyA group&#46; GO prevalence was 56&#37; for cases &#60;45&#44; and 26&#46;3&#37; for those &#62; 45 years old &#40;p &#61; 0&#46;001&#41;&#46; For groups with good&#44; fair or poor oral hygiene&#44; GO prevalence was 30&#46;3&#44; 60&#46;7 and 70&#46;6&#37; &#40;p&#60;0&#46;001&#41;&#46; In the multiple logistic regression analysis &#40;table 2&#41;&#44; GO prevalence increased with CyA use&#44; &#40;p &#60;0&#46;0001&#41;&#44; age &#60;45 years &#40;p &#60;0&#46;001&#41;&#44; and poor oral hygiene &#40;p &#60;0&#46;016&#41;&#44; and decreased with MMF &#40;p &#61; 0&#46;007&#41; and Aza &#40;p &#61; 0&#46;020&#41; use&#46; GO association with verapamil and nifedipine use was not statistically significant&#46; No association was found between GO and glomerular filtration rate or the diagnosis of diabetes mellitus&#46; We were not able to analyze oral steroids effect on GO&#44; because all cases used prednisone</p><p class="elsevierStylePara"><span class="elsevierStyleBold">DISCUSSION</span></p><p class="elsevierStylePara">GO in KT patients is a multifactorial condition&#46; It is triggered by gingival inflammation from mixed etiologies&#58; bacterial dental plaque&#44; chemical irritation by CyA secreted with saliva at crevicular sulcus&#44; and high CyA blood levels&#46;<span class="elsevierStyleSup">9&#44;10</span> Both situations generate aninflammatory response with mononuclear cell &#40;mainly lymphocyte&#41; infiltration&#44; fibroblast proliferation&#44; and extracellular matrix deposition&#46;<span class="elsevierStyleSup">5&#44;10</span> In this study&#44; a repeat observation has been made of a higher GO prevalence in CyA &#191; treated patients&#58; 59&#46;1&#37;&#44; vs&#46; 12&#46;0&#37; and 16&#46;7&#37; for patients treated with Tac and Siro respectively&#46;<span class="elsevierStyleSup">11&#44;7</span> The comparative effect with Tac has been previously known<span class="elsevierStyleSup">11&#44;12</span> In 2008&#44; Cota et al&#46; found a 20&#46;8&#37; GO prevalence in Sirolimus &#191; treated KT patients7 The striking 100&#37; GO prevalence in the eight CyA-alone &#40;plus prednisone&#41; cases&#44; as compared to 60&#46;2&#37; and 47&#46;2&#37; figures for CyA&#43;Aza and CyA&#43;MMF cases &#40;table 1&#41;&#44; a difference not accounted for by disparities in CsA dose or blood levels&#44; suggest unhindered CyA gum toxicity&#46; Other authors recognized a sparing effect of Aza on CyA- or Tac- associated GO prevalence and severity&#44; and point to gingival inflammation as a risk factor for developing GO&#46;<span class="elsevierStyleSup">4&#44;9&#44;11</span> Azathioprine&#191;s protective effect against the risk of GO has been explained by its antiproliferativa and anti-inflammatory action&#44; but it has also been recognized as having a proapoptotic effect on T cells&#46;<span class="elsevierStyleSup">15</span> As far as we know&#44; MMF has not previously been shown to have a protective effect against GO&#46; Our finding for this drug is that of a sparing effect&#44; quantitatively similar to that offered by Aza &#40;tables 1 and 2&#41;&#46; Some of MMF known actions include inhibiting T and B lymphocyte proliferation&#44; suppressing cell immunity and antibody production&#44; T-cell apoptosis&#44; antagonising IL-1 actions&#44; inhibiting lymphocyte and monocyte recruitment to the inflammation area&#44;<span class="elsevierStyleSup">16</span> inhibiting over-expression of the profibrotic agent TGF-b&#44;<span class="elsevierStyleSup">17</span> indirectly decreasing local tissue damage caused by macrophages&#44; and reducing the proliferation of arterial smooth muscle&#46;<span class="elsevierStyleSup">16</span> The gradual discovery of these actions has led to the use of MMF for nontransplant conditions&#44; and it has been shown to provide protection against tissue damage from autoinmune&#44; toxic&#44; or reduced renal mass causes&#44; sharing inflammation as tissue damaging mechanism <span class="elsevierStyleSup">18&#44;19</span> Some of these actions could explain MMF&#191;s protective effect against the development of GO in this patient group&#46; The review of CyA &#191; associated GO pathology and pathophysiology&#44; and the sparing effect of Aza and MMF&#44; prompts a consideration about parallel pathogenesis in chronic allograft nephropathy&#44; raising the hypothesis that CyA&#191;s known allograft nephrotoxicity does usually coexist with an as yet not clearly recognized opposing or buffering action by the secondary immunosuppressor drug&#44; hinted at by the 100&#37; GO prevalence in Cya-alone cases&#46; We weren&#191;t able to find an association between GO prevalence and severity&#44; on the one hand&#44; and kidney allograft function level&#44; on the other&#44; as other authors did<span class="elsevierStyleSup">20</span>&#44; possibly because of a rather short mean time from KT surgery in our group&#44; or perhaps because we weren&#191;t able to search for an association to earlier markers of allograft nephropathy&#44; instead of the late markers of a rising serum creatinine or a dropping GFR&#46;</p><p class="elsevierStylePara">GO prevalence is higher amoung young people&#46;<span class="elsevierStyleSup">9&#44;10</span> We found indeed a 5&#46;6 GO odds ratio in cases &#60;45&#44; as compared with patients &#62;45 years old&#46; As for poor oral hygiene&#44; the OR was 3&#46;2 as compared to good hygiene&#46; Previous studies explained these findings based on younger patients rising a stronger inflammatory response to poor oral hygiene&#44; and to hormonal differences&#46;<span class="elsevierStyleSup">9&#44;10</span> The 12&#37; GO prevalence found in the Tac group agree with findings from other studies&#59;<span class="elsevierStyleSup">5&#44;6</span> the observed severity was also low&#46; GO Risk factors from these studies were previous use of CyA&#44; use of Calcium channel blocker anti-hypertensives&#44;<span class="elsevierStyleSup">5</span> inflammation and gingival&#47;papillary bleeding&#44; and bacterial plaque deposits&#46;<span class="elsevierStyleSup">12&#44;21</span> The association between using Tac and GO has been called into question&#46; Some authors have reported partial or total resolution after substituting Tac for CyA&#46;<span class="elsevierStyleSup">22</span> Nassar et al&#46;<span class="elsevierStyleSup">23</span> concluded that Tac produces a less severe form of GE&#44; and the risk factor was the length of exposure to the drug&#46; In our cases treated with Tac&#44; GO prevalence was low and gum disease less severe&#46; We didn&#191;t find GO associated to calcium channel blocker antihypertensive drugs&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">CONCLUSIONS</span></p><p class="elsevierStylePara">MMF and Aza had a GO-sparing effect in this group of patients&#46;There will be a need to further explain the protecting mechanisms and to find out if these drugs do really grant a similar protective action on CyA nephrotoxicity in KT patients&#46;<br></br></p><p class="elsevierStylePara"><a href="grande&#47;41818078&#95;t1&#95;pag475&#46;jpg" class="elsevierStyleCrossRefs"><img src="41818078_t1_pag475.jpg" alt="Prevalence and severity of gingival overgrowth in groups using Cyclosporin A&#44; Tacrolimus&#44; or neither one"></img></a></p><p class="elsevierStylePara">Table 1&#46; Prevalence and severity of gingival overgrowth in groups using Cyclosporin A&#44; Tacrolimus&#44; or neither one</p><p class="elsevierStylePara"><a href="grande&#47;41818078&#95;t2&#95;pag476&#46;jpg" class="elsevierStyleCrossRefs"><img src="41818078_t2_pag476.jpg" alt="Multiple regression analysis&#44; risk factors for gingival overgrowth"></img></a></p><p class="elsevierStylePara">Table 2&#46; Multiple regression analysis&#44; risk factors for gingival overgrowth</p>"
    "pdfFichero" => "P-E-S-A418-EN.pdf"
    "tienePdf" => true
    "PalabrasClave" => array:2 [
      "es" => array:5 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec439723"
          "palabras" => array:1 [
            0 => "Hiperplasia gingival"
          ]
        ]
        1 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec439725"
          "palabras" => array:1 [
            0 => "Ciclosporina A"
          ]
        ]
        2 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec439727"
          "palabras" => array:1 [
            0 => "Micofenolato de mofetilo"
          ]
        ]
        3 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec439729"
          "palabras" => array:1 [
            0 => "Azatioprina"
          ]
        ]
        4 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec439731"
          "palabras" => array:1 [
            0 => "Trasplante renal"
          ]
        ]
      ]
      "en" => array:5 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec439724"
          "palabras" => array:1 [
            0 => "Gingival overgrowth"
          ]
        ]
        1 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec439726"
          "palabras" => array:1 [
            0 => "Cyclosporin A"
          ]
        ]
        2 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec439728"
          "palabras" => array:1 [
            0 => "Mofetil mycophenolate"
          ]
        ]
        3 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec439730"
          "palabras" => array:1 [
            0 => "Azathioprine"
          ]
        ]
        4 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec439732"
          "palabras" => array:1 [
            0 => "Renal transplant"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "es" => array:1 [
        "resumen" => "<p class="elsevierStylePara">Objetivos&#58; determinar la prevalencia y gravedad de hiperplasia gingival en un grupo de pacientes con trasplante renal &#40;TR&#41; y analizar el efecto del uso de los inmunosupresores ciclosporina A &#40;CsA&#41;&#44; tacrolimus &#40;Tac&#41;&#44; sirolimus &#40;Siro&#41; y azatioprina &#40;Aza&#41; o micofenolato de mofetilo &#40;MMF&#41; sobre esta complicaci&#243;n&#46; M&#233;todos&#58; se clasific&#243; la presencia y gravedad de la hiperplasia gingival&#46; Se analiz&#243; el impacto de los medicamentos inmunosupresores&#44; edad&#44; higiene bucal&#44; verapamilo y nifedipina sobre esta complicaci&#243;n mediante regresi&#243;n log&#237;stica m&#250;ltiple&#46; Resultados&#58; fueron 172 pacientes&#46; Usaban CsA 137&#44; Tac 25&#44; Siro 6&#44; Aza 107 y MMF 56&#46; Tuvieron hiperplasia gingival el 59&#44;1&#37; con CsA&#44; 12&#44;0&#37; con Tac&#44; y 16&#44;7&#37; con Siro&#46; Aumentaron la frecuencia de hiperplasia gingival CsA con raz&#243;n de momios &#40;RM&#41; 15&#44;2&#44; edad &#60;45 a&#241;os con RM 5&#44;6 y mala higiene bucal con RM 3&#44;2&#44; y la disminuyeron Aza con RM 0&#44;05 y MMF con RM 0&#44;03&#46; Conclusiones&#58; Aza y MMF ofrecieron protecci&#243;n significativa contra el desarrollo de hiperplasia gingival en este grupo de pacientes con TR&#46;</p>"
      ]
      "en" => array:1 [
        "resumen" => "Aim&#58; To assess gingival overgrowth prevalence and severity in a group of kidney transplant &#40;KT&#41; patients&#44; and analyze the effect of immunosuppressor drugs Cyclosporin A &#40;CyA&#41;&#44; Tacrolimus &#40;Tac&#41;&#44; Sirolimus &#40;Siro&#41;&#44; Azathioprine &#40;Aza&#41; and Mofetil Mycophenolate on this complication&#46; Methods&#58; Gingival overgrowth presence and severity was classified&#44; and the impact of immunosuppressor drugs&#44; age&#44; oral hygiene&#44; verapamil and nifedipine on this condition was analyzed by multiple logistic regression&#46; Results&#58; 172 KT pts&#46; were examined&#59; 137 used CyA&#44; 25 Tac&#44; 6 Sirolimus&#44; 107 Aza and 56 MMF&#46; Gingival overgrowth prevalence was 59&#46;1&#37; on CyA&#44; 12&#46;0&#37; on Tac&#44; and 16&#46;7&#37; on Sirolimus&#46; CyA odds ratio &#40;OR&#41; 15&#46;2&#44; age <45 or 5 6 and poor oral hygiene 3 2 increased aza 0 05 mmf 03 decreased go prevalence conclusions: effect was a significant protection against in this group of kt patients</45>"
      ]
    ]
    "multimedia" => array:2 [
      0 => array:8 [
        "identificador" => "fig1"
        "etiqueta" => "Tab.  1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "41818078_t1_pag475.jpg"
            "Alto" => 272
            "Ancho" => 828
            "Tamanyo" => 51997
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Prevalence and severity of gingival overgrowth in groups using Cyclosporin A&#44; Tacrolimus&#44; or neither one"
        ]
      ]
      1 => array:8 [
        "identificador" => "fig2"
        "etiqueta" => "Tab.  2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "41818078_t2_pag476.jpg"
            "Alto" => 176
            "Ancho" => 828
            "Tamanyo" => 34494
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Multiple regression analysis&#44; risk factors for gingival overgrowth"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliography"
      "seccion" => array:1 [
        0 => array:1 [
          "bibliografiaReferencia" => array:24 [
            0 => array:3 [
              "identificador" => "bib1"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Danovitch GM. Immunosuppressive medications and protocols for kidney transplantation. En: Davinovitch GM, editor. Handbook of Kidney transplantation. Fourth edition, Philadelphia USA: Lippincott Williams & Wilkins; 2005;72-134."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib2"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "De la Rosa GE, Mondragón PA, Irigoyen CME, Bustamante RMA. Oral lesions in a group of kidney transplant patients. Med Oral Patol Oral Cir Bucal 2005;10:196-204.  <a href="http://www.ncbi.nlm.nih.gov/pubmed/15876960" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib3"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Al-Mohaya MA, Darwazeh AM, Bin-Salih S, Al-Khudair W. Oral lesions in Saudi renal transplant patients. Saudi J Kidney Dis Transpl 2009;20:20-9.  <a href="http://www.ncbi.nlm.nih.gov/pubmed/19112215" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib4"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Pernu HE, Pernu LMH, Huttunen KRH, Nieminen PA, Knuuttila MLE. Gingival overgrowth among renal transplant recipients related to immunosuppressive"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib5"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "medication and possible local background factors. J Periodontol 1992;63:548-53.  <a href="http://www.ncbi.nlm.nih.gov/pubmed/1625155" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib6"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Chae H-J, Ha M-S, Yun D-H, Pae H-O, Chung H-T, Chae S-W, et al. Mechanism of cyclosporine-induced overgrowth in gingiva. J Dent Res 2006;85:515-9.  <a href="http://www.ncbi.nlm.nih.gov/pubmed/16723647" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib7"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Costa FO, Ferreira SD, Cota LO, Costa JE, Aguilar MA. Prevalence, severity, and risk variables associated with gingival overgrowth in renal transplant subjects treated under tacrolimus or cyclosporin regimens. J Periodontol 2006;77:969-75.  <a href="http://www.ncbi.nlm.nih.gov/pubmed/16734570" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib8"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Cota LO, Oliveira AP, Costa JE, Cortelli SC, Costa FO. Gingival status of Brazilian renal transplant recipients under sirolimus-based regimens. J Periodontol 2008;9:2060-8."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib9"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Silness J, Loe H. Periodontal disease in pregnancy: correlation between oral hygiene and periodontal condition. Acta Odontol Scand 1964;22;131-5."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Somacarrera ML, Hernández G, Acero J, Moskow BS. Factors related to the incidence and severity of cyclosporin-induced gingival overgrowth in transplant patients. A longitudinal study. J Periodontol 1994;65:671-5.  <a href="http://www.ncbi.nlm.nih.gov/pubmed/7608843" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib11"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Seymour RA, Ellis JS, Thomanson JM. Risk factors for drug-induced gingival overgrowth. J Clin Periodontol 2000;27:217-23.  <a href="http://www.ncbi.nlm.nih.gov/pubmed/10783833" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib12"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Ellis JS, Seymour RA, Taylor JJ, Thomason JM. Prevalence of gingival overgrowth in transplant patients immunosuppressed with tacrolimus. J Clin Periodontol 2004;31:126-31.  <a href="http://www.ncbi.nlm.nih.gov/pubmed/15016038" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib13"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Sekiguchi RT, Paixão CG, Saraiva L, Romito GA, Pannuti CM, Lotufo RFM. Incidence of tacrolimus-induced gingival overgrowth in the absence of calcium channel blockers; a short-term study. J Clin Periodontol 2007;34:545-50.  <a href="http://www.ncbi.nlm.nih.gov/pubmed/17433046" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib14"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Thomason JM, Seymour RA, Ellis JS. Risk factors for gingival overgrowth in patients medicated with ciclosporin in the absence of calcium channel blockers. J Clin Periodontol 2005;32:273-9.  <a href="http://www.ncbi.nlm.nih.gov/pubmed/15766370" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib15"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Cara CJ, Pena AS, Sans M, Rodrigo L, Guerrero-Esteo M, Hinojosa J, et al. Reviewing the mechanism of action of thiopurine drugs: towards a new paradigm in clinical practice. Med Sci Monit 2004;10:RA247-54.  <a href="http://www.ncbi.nlm.nih.gov/pubmed/15507865" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib16"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Schachner T, Heiss S, Zipponi D, Tzankov A, Bernecker O, Kroell A, et al. Perivascular treatment with azathioprine reduces neointimal hyperplasia in experimental vein grafts. Heart Surg Forum 2006;9:E515-7.  <a href="http://www.ncbi.nlm.nih.gov/pubmed/16401538" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib17"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Allison AC, Eugui EM. Mechanisms of action of mycophenolate mofetil in preventing acute and chronic allograft rejection. Transplantation 2005;15:S181-90."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib18"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Naesens M, Kuypers DR, Sarwal M. Calcineurin inhibitor nephrotoxicity. Clin J Am Soc Nephrol 2009;4:481-508.  <a href="http://www.ncbi.nlm.nih.gov/pubmed/19218475" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib19"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Bravo Y, Quiroz Y, Ferrebuz A, Vaziri ND, Rodríguez-Iturbe B. Mycophenolate mofetil administration reduces renal inflammation, oxidative stress, and arterial pressure in rats with lead-induced hypertension. Am J Physiol Renal Physiol 2007;293:F616-23.  <a href="http://www.ncbi.nlm.nih.gov/pubmed/17567935" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib20"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Walsh M, James M, Jayne D, Tonelli M, Manns BJ, Hemmelgarn BR. Mycophenolate mofetil for induction therapy of lupus nephritis: A systematic review and meta-analysis. Clin J Am Soc Nephrol 2007;2:968-75.  <a href="http://www.ncbi.nlm.nih.gov/pubmed/17702723" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib21"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Boraty¿ska M, Radwan-Oczko M, Falkiewicz K, Klinger M, Szyber P. Gingival overgrowth in kidney transplant recipients treated with cyclosporine and its relationship with chronic graft nephropathy. Transplant Proc 2003;35:2238-40.  <a href="http://www.ncbi.nlm.nih.gov/pubmed/14529900" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib22"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Cezário ES, Cota LO, Ferreira SD, Siqueira FM, Soares RV, Zenóbio EG, Costa FO. Gingival overgrowth in renal transplant subjects medicated with tacrolimus in the absence of calcium channel blockers. Transplantation 2008;85:232-6.  <a href="http://www.ncbi.nlm.nih.gov/pubmed/18212628" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib23"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Hernández G, Arriba L, Frías MC, de la Marroca JC, Vicente JC, Jiménez C, et al. Conversion from cyclosporin A to tacrolimus as a non-surgical alternative to reduce gingival enlargement: a preliminary case series. J Periodontol 2003;74:1816-23.  <a href="http://www.ncbi.nlm.nih.gov/pubmed/14974825" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib24"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Nassar CA, Nassar PO, Andia DC, Guimarães MR, Spolidorio LC. The effects of up to 240 days of tacrolimus therapy on the gingival tissues of rats- a morphological evaluation. Oral Dis 2008;14:67-72.  <a href="http://www.ncbi.nlm.nih.gov/pubmed/18173451" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/20132514/0000002900000005/v0_201502091625/X2013251409003711/v0_201502091626/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "35444"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Short Originals"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/20132514/0000002900000005/v0_201502091625/X2013251409003711/v0_201502091626/en/P-E-S-A418-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251409003711?idApp=UINPBA000064"
]
Share
Journal Information

Statistics

Follow this link to access the full text of the article

The effect of mycophenolate mophetil and azathioprine on gingival overgrowth associated with cyclosporin A use in kidney transplant patients
Efecto del micofenolato de mofetilo y azatioprina sobre la hiperplasia gingival asociada al uso de ciclosporina A en pacientes con trasplante renal
E.. de la Rosa Garcíaa, A.. Mondragón Padillaa
a Departamento de Atención a la Salud, Universidad Autónoma Metropolitana Xoch. Servicio de Nefrología, Hospital General de Zona 50, Instituto Mexicano del Seguro Social, San Luis Potosí, México,
Read
9864
Times
was read the article
2436
Total PDF
7428
Total HTML
Share statistics
 array:21 [
  "pii" => "X2013251409003711"
  "issn" => "20132514"
  "doi" => "10.3265/Nefrologia.2009.29.5.5413.en.full"
  "estado" => "S300"
  "fechaPublicacion" => "2009-10-01"
  "documento" => "article"
  "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
  "subdocumento" => "fla"
  "cita" => "Nefrologia &#40;English Version&#41;. 2009;29:474-8"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 4663
    "formatos" => array:3 [
      "EPUB" => 275
      "HTML" => 3834
      "PDF" => 554
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:17 [
      "pii" => "X0211699509003714"
      "issn" => "02116995"
      "doi" => "10.3265/Nefrologia.2009.29.5.5413.en.full"
      "estado" => "S300"
      "fechaPublicacion" => "2009-10-01"
      "documento" => "article"
      "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
      "subdocumento" => "fla"
      "cita" => "Nefrologia. 2009;29:474-8"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 9942
        "formatos" => array:3 [
          "EPUB" => 260
          "HTML" => 9113
          "PDF" => 569
        ]
      ]
      "es" => array:11 [
        "idiomaDefecto" => true
        "titulo" => "Efecto del micofenolato de mofetilo y azatioprina sobre la hiperplasia gingival asociada al uso de ciclosporina A en pacientes con trasplante renal"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "474"
            "paginaFinal" => "478"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "The effect of mycophenolate mophetil and azathioprine on gingival overgrowth associated with cyclosporin A use in kidney transplant patients"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "E. de la Rosa Garc&#237;a, A. Mondrag&#243;n Padilla"
            "autores" => array:2 [
              0 => array:2 [
                "Iniciales" => "E."
                "apellidos" => "de la Rosa Garc&#237;a"
              ]
              1 => array:2 [
                "Iniciales" => "A."
                "apellidos" => "Mondrag&#243;n Padilla"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "X2013251409003711"
          "doi" => "10.3265/Nefrologia.2009.29.5.5413.en.full"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251409003711?idApp=UINPBA000064"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699509003714?idApp=UINPBA000064"
      "url" => "/02116995/0000002900000005/v0_201502091404/X0211699509003714/v0_201502091405/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:17 [
    "pii" => "X2013251409003887"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.2009.29.5.5324.en.full"
    "estado" => "S300"
    "fechaPublicacion" => "2009-10-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia &#40;English Version&#41;. 2009;29:479-81"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 5014
      "formatos" => array:3 [
        "EPUB" => 223
        "HTML" => 3997
        "PDF" => 794
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "titulo" => "Coeliac disease and membranous nephropathy"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "479"
          "paginaFinal" => "481"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Enfermedad cel&#237;aca y nefropat&#237;a membranosa"
        ]
      ]
      "contieneResumen" => array:2 [
        "es" => true
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig1"
          "etiqueta" => "Fig. 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "copyright" => "Elsevier Espa&#241;a"
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "41918078_f1_pag480.jpg"
              "Alto" => 320
              "Ancho" => 398
              "Tamanyo" => 15886
            ]
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "S. Soro, M.D. S&#225;nchez de la Nieta, F. Rivera"
          "autores" => array:3 [
            0 => array:2 [
              "Iniciales" => "S."
              "apellidos" => "Soro"
            ]
            1 => array:2 [
              "Iniciales" => "M.D."
              "apellidos" => "S&#225;nchez de la Nieta"
            ]
            2 => array:2 [
              "Iniciales" => "F."
              "apellidos" => "Rivera"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X021169950900388X"
        "doi" => "10.3265/Nefrologia.2009.29.5.5324.en.full"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X021169950900388X?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251409003887?idApp=UINPBA000064"
    "url" => "/20132514/0000002900000005/v0_201502091625/X2013251409003887/v0_201502091626/en/main.assets"
  ]
  "itemAnterior" => array:17 [
    "pii" => "X2013251409003621"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.2009.29.5.5493.en.full"
    "estado" => "S300"
    "fechaPublicacion" => "2009-10-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia &#40;English Version&#41;. 2009;29:464-73"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 5791
      "formatos" => array:3 [
        "EPUB" => 264
        "HTML" => 4817
        "PDF" => 710
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "titulo" => "Study of oxidative stress in advanced kidney disease"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "464"
          "paginaFinal" => "473"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Estudio del estr&#233;s oxidativo en enfermedad renal avanzada"
        ]
      ]
      "contieneResumen" => array:2 [
        "es" => true
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig1"
          "etiqueta" => "Tab.  1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "copyright" => "Elsevier Espa&#241;a"
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "41718078_t1_pag466.jpg"
              "Alto" => 117
              "Ancho" => 828
              "Tamanyo" => 18148
            ]
          ]
          "descripcion" => array:1 [
            "en" => "Characteristics of the groups under study"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "M.J. Puchades Montesa, M.A. Gonz&#225;lez Rico, M.A. Sol&#237;s Salguero, I. Torregrosa Maicas, I. Juan Garc&#237;a, A. Miguel Carrasco, M.C. Tormos Mu&#241;oz, G. S&#225;ez Tormo"
          "autores" => array:8 [
            0 => array:2 [
              "Iniciales" => "M.J."
              "apellidos" => "Puchades Montesa"
            ]
            1 => array:2 [
              "Iniciales" => "M.A."
              "apellidos" => "Gonz&#225;lez Rico"
            ]
            2 => array:2 [
              "Iniciales" => "M.A."
              "apellidos" => "Sol&#237;s Salguero"
            ]
            3 => array:2 [
              "Iniciales" => "I."
              "apellidos" => "Torregrosa Maicas"
            ]
            4 => array:2 [
              "Iniciales" => "I."
              "apellidos" => "Juan Garc&#237;a"
            ]
            5 => array:2 [
              "Iniciales" => "A."
              "apellidos" => "Miguel Carrasco"
            ]
            6 => array:2 [
              "Iniciales" => "M.C."
              "apellidos" => "Tormos Mu&#241;oz"
            ]
            7 => array:2 [
              "Iniciales" => "G."
              "apellidos" => "S&#225;ez Tormo"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X0211699509003624"
        "doi" => "10.3265/Nefrologia.2009.29.5.5493.en.full"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699509003624?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251409003621?idApp=UINPBA000064"
    "url" => "/20132514/0000002900000005/v0_201502091625/X2013251409003621/v0_201502091626/en/main.assets"
  ]
  "en" => array:15 [
    "idiomaDefecto" => true
    "titulo" => "The effect of mycophenolate mophetil and azathioprine on gingival overgrowth associated with cyclosporin A use in kidney transplant patients"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "474"
        "paginaFinal" => "478"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "E. de la Rosa Garc&#237;a, A. Mondrag&#243;n Padilla"
        "autores" => array:2 [
          0 => array:4 [
            "Iniciales" => "E."
            "apellidos" => "de la Rosa Garc&#237;a"
            "email" => array:1 [
              0 => "delarosa0712&#64;msn&#46;com"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          1 => array:3 [
            "Iniciales" => "A."
            "apellidos" => "Mondrag&#243;n Padilla"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:3 [
            "entidad" => "Departamento de Atención a la Salud, Universidad Autónoma Metropolitana Xoch. Servicio de Nefrología, Hospital General de Zona 50, Instituto Mexicano del Seguro Social, San Luis Potosí,  México, "
            "etiqueta" => "<span class="elsevierStyleSup">a</span>"
            "identificador" => "affa"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Efecto del micofenolato de mofetilo y azatioprina sobre la hiperplasia gingival asociada al uso de ciclosporina A en pacientes con trasplante renal"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:8 [
        "identificador" => "fig1"
        "etiqueta" => "Tab.  1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "41818078_t1_pag475.jpg"
            "Alto" => 272
            "Ancho" => 828
            "Tamanyo" => 51997
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Prevalence and severity of gingival overgrowth in groups using Cyclosporin A&#44; Tacrolimus&#44; or neither one"
        ]
      ]
    ]
    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">INTRODUCTION</span></p><p class="elsevierStylePara">The use of cyclosporin A or tacrolimus in kidney transplant patients is frequently accompanied by side effects&#46;<span class="elsevierStyleSup">1</span> Oral Adverse effects are mainly cosmetic&#44; but opportunistic fungal or viral infections may also flare up&#46;<span class="elsevierStyleSup">2&#44;3</span> The most common orallesion is the firm&#44; lobulated enlargement of the gums known as gingival overgrowth &#40;GO&#41; or gingival hyperplasia&#44; with reported prevalence as high as 74&#37;&#44;<span class="elsevierStyleSup">2-4</span> arising as a result of the interplay of several factors&#44; including CyA and calcium channel blocker anti-hypertensive drugs use&#44; gingival inflammation and poor oral higiene&#46;<span class="elsevierStyleSup">4</span> Histologically&#44; GO is marked by fibroblast proliferation&#44; deposition of amorphous extracellular material and mononuclear inflammatory infiltrate&#46;<span class="elsevierStyleSup">5</span> Tac - associated GO prevalence is much lower&#46;<span class="elsevierStyleSup">6</span> There have been only a few literature reports on Sirolimus - associated GO&#46;<span class="elsevierStyleSup">7</span></p><p class="elsevierStylePara">The aims of the study were to assess GO prevalence and severity in a group of KT patients using CyA&#44; Tac or Siro as principal immunosuppressor drugs and to evaluate the effect of the following factors on GO prevalence&#58; use of Aza or MMF as a secondary immunosuppressor drug&#44; calcium channel blocker anti-hypertensive drugs&#44; kidney graft function level&#44; fasting glycemia&#44; oral hygiene and age&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">MATERIAL AND METHODS</span></p><p class="elsevierStylePara">It was a cross &#191; sectional study&#44; carried out in the nephrology service outpatient clinic at HGZ &#35; 50 IMSS&#44; San Luis Potos&#237;&#46; The study was approved by the hospital&#191;s research and ethics committees&#46; All participants were asked for permission to perform an oral examination&#44; which included an evaluation of gingival overgrowth and oral hygiene&#46; Consecutive KT cases attending nephrology consultation follow &#191; up were examined&#46; The total group was split into cases using CyA&#44; Tac or Siro as principal immunosuppresor drug&#46; Demographic and clinical data was gathered from medical records&#44; including cause of end stage renal disease before KT&#44; elapsed time since transplant surgery&#44; CyA&#44; Tac and Siro doses and blood levels&#44; use of MMF or Aza&#44; use of Calcium channel blocker anti-hypertensives&#44; and laboratory results&#46; For GO diagnostic evaluation purposes&#44; the dental arches were divided into sextants &#40;three upper and three lower&#41;&#46; GO severity was classified into four categories using the criteria established by Pernu et al&#46;&#58;<span class="elsevierStyleSup">4</span> score 0&#44; no gingival overgrowth&#59; score 1&#44; slight overgrowth with thickening of marginal gum tissue&#59; score 2&#44; moderate gum overgrowth extending to half of the crown&#44; and score 3&#44; severe overgrowth&#44; covering two thirds of the crown and affecting Inserted gum&#46; Oral hygiene was classified as good&#44; fair&#44; or poor according to the simplified oral hygiene index&#44;8 assessing amount and location of bacterial plaque on tooth crowns&#46; We carried out a descriptive statistical analysis for the following demographic and clinical variables&#58; sex&#44; age&#44; body mass index&#44; cause of end stage renal disease before KT&#44; elapsed time since transplant&#44; medications used and clinical laboratory results&#46; Continuous variables were compared using the Student t-test or ANOVA&#44; and proportions using Chi2&#46; Associations were analysed with Chi2 or multiple logistic regression as applicable&#44; using Excel 2007 and Epi Info version 3&#46;4&#46;3&#46; The multiple logistic regression model included independent variables potentially associated with GO&#44; i&#46;e sex&#44; age&#44; oral hygiene&#44; CyA&#44; Tac or Siro doses and blood levels&#44; secondary immunosuppressor drug and doses&#44; calcium channel blocker anti-hypertensive drugs&#44; elapsed time since kidney transplant and diabetes&#46; Variables with a value p &#62; 0&#46;50 were excluded from subsequent analyses&#46; Values of p &#60; 0&#46;05 were considered statistically significant&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">RESULTS</span></p><p class="elsevierStylePara">The study included 172 kidney transplant patients&#58; 103 men and 69 women&#44; aged 33&#46;0 &#177; 13&#46;7 &#40;9 to 66&#41; years&#59; 48 &#40;27&#46;9&#37;&#41; had a primary-level education or lower&#46; 19 patients &#40;11&#46;2&#37;&#41; were diabetic before KT and nine others &#40;5&#46;3&#37;&#41; had a fasting glycemia &#62; 126mg&#47;dl on lab results closer to oral examination date&#46; Mean elapsed time post &#191; KT was 22 &#40;1&#191;157&#41; months&#46; Ten patients were transplanted three or less months before oral examination&#46; Serum creatinine was 1&#46;4 &#177; 0&#46;4 mg&#47;dl&#44; for an estimated glomerular filtration rate &#40;Levey&#41; of 66 &#177; 28ml&#47;min&#46; The principal immunosuppressor drug was CyA in 137 patients&#44; Tac in 25&#44; Siro in 6 and Aza in 4 &#40;table 1&#41;&#46; The secondary immunosuppressor was Aza in 107 cases&#44; MMF in 56 and Siro in just one patient&#46; Mean CyA and Tac doses were 3&#46;0 and 0&#46;016 mg&#47;kg&#47;day&#44; Siro 2&#46;0 mg&#47;day&#44; MMF 1&#46;25 g&#47;day&#44; Aza 1&#46;4 mg&#47;kg&#47;day and prednisone 0&#46;14 mg&#47;kg&#47;day&#46; Eight cases used CyA &#40;plus prednisone&#41; but not a secondary immunosuppressor&#44; and ten used neither CyA or Tac&#46; GO prevalence with CyA as the principal immunosuppressor was 59&#46;1&#37;&#44; 12&#46;0&#37; with Tac&#44; and 16&#46;7&#37; with Siro&#46; Within the CyA group&#44; GO prevalence was 60&#46;2&#37; for Aza&#44; and 47&#46;2&#37; for MMF subgroups&#44; p&#61;0&#46;18&#44; and 100&#37; in those cases not using a secondary immunosuppressor&#44; p &#61; 0&#44;015 vs&#46; the combined CyA&#43;Aza and CyA&#43;MMF group &#40;Table 1&#41;&#46; There were no differences in the degree of CyA exposure among subgroups using CyA &#43; Aza&#44; CyA &#43; MMF and CyA alone&#44; whether measured by mg&#47;kg&#47;day dosage&#44; with CyA &#43; Aza 3&#46;5 &#177; 1&#46;6&#44; CyA &#43; MMF 3&#46;4 &#177; 1&#46;9 and CyA alone 3&#46;3 &#177; 1&#46;1&#44; p &#62; 0&#46;50&#44; ANOVA&#44; or by C12 CyA blood levels with CyA &#43; Aza 175 &#177; 52&#44; CyA &#43; MMF 174 &#177; 52&#44; and CyA alone 156 &#177; 53 ng&#47;ml&#44; p &#62;0&#44;50&#44; ANOVA&#46; Concerning the effect of other drugs associated with gingival overgrowth&#44; 95 cases used verapamil and 17&#44; nifedipine&#59; out of those groups&#44; 76 and 13 patients&#44; respectively&#44; belonged to the CyA group&#46; GO prevalence was 56&#37; for cases &#60;45&#44; and 26&#46;3&#37; for those &#62; 45 years old &#40;p &#61; 0&#46;001&#41;&#46; For groups with good&#44; fair or poor oral hygiene&#44; GO prevalence was 30&#46;3&#44; 60&#46;7 and 70&#46;6&#37; &#40;p&#60;0&#46;001&#41;&#46; In the multiple logistic regression analysis &#40;table 2&#41;&#44; GO prevalence increased with CyA use&#44; &#40;p &#60;0&#46;0001&#41;&#44; age &#60;45 years &#40;p &#60;0&#46;001&#41;&#44; and poor oral hygiene &#40;p &#60;0&#46;016&#41;&#44; and decreased with MMF &#40;p &#61; 0&#46;007&#41; and Aza &#40;p &#61; 0&#46;020&#41; use&#46; GO association with verapamil and nifedipine use was not statistically significant&#46; No association was found between GO and glomerular filtration rate or the diagnosis of diabetes mellitus&#46; We were not able to analyze oral steroids effect on GO&#44; because all cases used prednisone</p><p class="elsevierStylePara"><span class="elsevierStyleBold">DISCUSSION</span></p><p class="elsevierStylePara">GO in KT patients is a multifactorial condition&#46; It is triggered by gingival inflammation from mixed etiologies&#58; bacterial dental plaque&#44; chemical irritation by CyA secreted with saliva at crevicular sulcus&#44; and high CyA blood levels&#46;<span class="elsevierStyleSup">9&#44;10</span> Both situations generate aninflammatory response with mononuclear cell &#40;mainly lymphocyte&#41; infiltration&#44; fibroblast proliferation&#44; and extracellular matrix deposition&#46;<span class="elsevierStyleSup">5&#44;10</span> In this study&#44; a repeat observation has been made of a higher GO prevalence in CyA &#191; treated patients&#58; 59&#46;1&#37;&#44; vs&#46; 12&#46;0&#37; and 16&#46;7&#37; for patients treated with Tac and Siro respectively&#46;<span class="elsevierStyleSup">11&#44;7</span> The comparative effect with Tac has been previously known<span class="elsevierStyleSup">11&#44;12</span> In 2008&#44; Cota et al&#46; found a 20&#46;8&#37; GO prevalence in Sirolimus &#191; treated KT patients7 The striking 100&#37; GO prevalence in the eight CyA-alone &#40;plus prednisone&#41; cases&#44; as compared to 60&#46;2&#37; and 47&#46;2&#37; figures for CyA&#43;Aza and CyA&#43;MMF cases &#40;table 1&#41;&#44; a difference not accounted for by disparities in CsA dose or blood levels&#44; suggest unhindered CyA gum toxicity&#46; Other authors recognized a sparing effect of Aza on CyA- or Tac- associated GO prevalence and severity&#44; and point to gingival inflammation as a risk factor for developing GO&#46;<span class="elsevierStyleSup">4&#44;9&#44;11</span> Azathioprine&#191;s protective effect against the risk of GO has been explained by its antiproliferativa and anti-inflammatory action&#44; but it has also been recognized as having a proapoptotic effect on T cells&#46;<span class="elsevierStyleSup">15</span> As far as we know&#44; MMF has not previously been shown to have a protective effect against GO&#46; Our finding for this drug is that of a sparing effect&#44; quantitatively similar to that offered by Aza &#40;tables 1 and 2&#41;&#46; Some of MMF known actions include inhibiting T and B lymphocyte proliferation&#44; suppressing cell immunity and antibody production&#44; T-cell apoptosis&#44; antagonising IL-1 actions&#44; inhibiting lymphocyte and monocyte recruitment to the inflammation area&#44;<span class="elsevierStyleSup">16</span> inhibiting over-expression of the profibrotic agent TGF-b&#44;<span class="elsevierStyleSup">17</span> indirectly decreasing local tissue damage caused by macrophages&#44; and reducing the proliferation of arterial smooth muscle&#46;<span class="elsevierStyleSup">16</span> The gradual discovery of these actions has led to the use of MMF for nontransplant conditions&#44; and it has been shown to provide protection against tissue damage from autoinmune&#44; toxic&#44; or reduced renal mass causes&#44; sharing inflammation as tissue damaging mechanism <span class="elsevierStyleSup">18&#44;19</span> Some of these actions could explain MMF&#191;s protective effect against the development of GO in this patient group&#46; The review of CyA &#191; associated GO pathology and pathophysiology&#44; and the sparing effect of Aza and MMF&#44; prompts a consideration about parallel pathogenesis in chronic allograft nephropathy&#44; raising the hypothesis that CyA&#191;s known allograft nephrotoxicity does usually coexist with an as yet not clearly recognized opposing or buffering action by the secondary immunosuppressor drug&#44; hinted at by the 100&#37; GO prevalence in Cya-alone cases&#46; We weren&#191;t able to find an association between GO prevalence and severity&#44; on the one hand&#44; and kidney allograft function level&#44; on the other&#44; as other authors did<span class="elsevierStyleSup">20</span>&#44; possibly because of a rather short mean time from KT surgery in our group&#44; or perhaps because we weren&#191;t able to search for an association to earlier markers of allograft nephropathy&#44; instead of the late markers of a rising serum creatinine or a dropping GFR&#46;</p><p class="elsevierStylePara">GO prevalence is higher amoung young people&#46;<span class="elsevierStyleSup">9&#44;10</span> We found indeed a 5&#46;6 GO odds ratio in cases &#60;45&#44; as compared with patients &#62;45 years old&#46; As for poor oral hygiene&#44; the OR was 3&#46;2 as compared to good hygiene&#46; Previous studies explained these findings based on younger patients rising a stronger inflammatory response to poor oral hygiene&#44; and to hormonal differences&#46;<span class="elsevierStyleSup">9&#44;10</span> The 12&#37; GO prevalence found in the Tac group agree with findings from other studies&#59;<span class="elsevierStyleSup">5&#44;6</span> the observed severity was also low&#46; GO Risk factors from these studies were previous use of CyA&#44; use of Calcium channel blocker anti-hypertensives&#44;<span class="elsevierStyleSup">5</span> inflammation and gingival&#47;papillary bleeding&#44; and bacterial plaque deposits&#46;<span class="elsevierStyleSup">12&#44;21</span> The association between using Tac and GO has been called into question&#46; Some authors have reported partial or total resolution after substituting Tac for CyA&#46;<span class="elsevierStyleSup">22</span> Nassar et al&#46;<span class="elsevierStyleSup">23</span> concluded that Tac produces a less severe form of GE&#44; and the risk factor was the length of exposure to the drug&#46; In our cases treated with Tac&#44; GO prevalence was low and gum disease less severe&#46; We didn&#191;t find GO associated to calcium channel blocker antihypertensive drugs&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">CONCLUSIONS</span></p><p class="elsevierStylePara">MMF and Aza had a GO-sparing effect in this group of patients&#46;There will be a need to further explain the protecting mechanisms and to find out if these drugs do really grant a similar protective action on CyA nephrotoxicity in KT patients&#46;<br></br></p><p class="elsevierStylePara"><a href="grande&#47;41818078&#95;t1&#95;pag475&#46;jpg" class="elsevierStyleCrossRefs"><img src="41818078_t1_pag475.jpg" alt="Prevalence and severity of gingival overgrowth in groups using Cyclosporin A&#44; Tacrolimus&#44; or neither one"></img></a></p><p class="elsevierStylePara">Table 1&#46; Prevalence and severity of gingival overgrowth in groups using Cyclosporin A&#44; Tacrolimus&#44; or neither one</p><p class="elsevierStylePara"><a href="grande&#47;41818078&#95;t2&#95;pag476&#46;jpg" class="elsevierStyleCrossRefs"><img src="41818078_t2_pag476.jpg" alt="Multiple regression analysis&#44; risk factors for gingival overgrowth"></img></a></p><p class="elsevierStylePara">Table 2&#46; Multiple regression analysis&#44; risk factors for gingival overgrowth</p>"
    "pdfFichero" => "P-E-S-A418-EN.pdf"
    "tienePdf" => true
    "PalabrasClave" => array:2 [
      "es" => array:5 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec439723"
          "palabras" => array:1 [
            0 => "Hiperplasia gingival"
          ]
        ]
        1 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec439725"
          "palabras" => array:1 [
            0 => "Ciclosporina A"
          ]
        ]
        2 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec439727"
          "palabras" => array:1 [
            0 => "Micofenolato de mofetilo"
          ]
        ]
        3 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec439729"
          "palabras" => array:1 [
            0 => "Azatioprina"
          ]
        ]
        4 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec439731"
          "palabras" => array:1 [
            0 => "Trasplante renal"
          ]
        ]
      ]
      "en" => array:5 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec439724"
          "palabras" => array:1 [
            0 => "Gingival overgrowth"
          ]
        ]
        1 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec439726"
          "palabras" => array:1 [
            0 => "Cyclosporin A"
          ]
        ]
        2 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec439728"
          "palabras" => array:1 [
            0 => "Mofetil mycophenolate"
          ]
        ]
        3 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec439730"
          "palabras" => array:1 [
            0 => "Azathioprine"
          ]
        ]
        4 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec439732"
          "palabras" => array:1 [
            0 => "Renal transplant"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "es" => array:1 [
        "resumen" => "<p class="elsevierStylePara">Objetivos&#58; determinar la prevalencia y gravedad de hiperplasia gingival en un grupo de pacientes con trasplante renal &#40;TR&#41; y analizar el efecto del uso de los inmunosupresores ciclosporina A &#40;CsA&#41;&#44; tacrolimus &#40;Tac&#41;&#44; sirolimus &#40;Siro&#41; y azatioprina &#40;Aza&#41; o micofenolato de mofetilo &#40;MMF&#41; sobre esta complicaci&#243;n&#46; M&#233;todos&#58; se clasific&#243; la presencia y gravedad de la hiperplasia gingival&#46; Se analiz&#243; el impacto de los medicamentos inmunosupresores&#44; edad&#44; higiene bucal&#44; verapamilo y nifedipina sobre esta complicaci&#243;n mediante regresi&#243;n log&#237;stica m&#250;ltiple&#46; Resultados&#58; fueron 172 pacientes&#46; Usaban CsA 137&#44; Tac 25&#44; Siro 6&#44; Aza 107 y MMF 56&#46; Tuvieron hiperplasia gingival el 59&#44;1&#37; con CsA&#44; 12&#44;0&#37; con Tac&#44; y 16&#44;7&#37; con Siro&#46; Aumentaron la frecuencia de hiperplasia gingival CsA con raz&#243;n de momios &#40;RM&#41; 15&#44;2&#44; edad &#60;45 a&#241;os con RM 5&#44;6 y mala higiene bucal con RM 3&#44;2&#44; y la disminuyeron Aza con RM 0&#44;05 y MMF con RM 0&#44;03&#46; Conclusiones&#58; Aza y MMF ofrecieron protecci&#243;n significativa contra el desarrollo de hiperplasia gingival en este grupo de pacientes con TR&#46;</p>"
      ]
      "en" => array:1 [
        "resumen" => "Aim&#58; To assess gingival overgrowth prevalence and severity in a group of kidney transplant &#40;KT&#41; patients&#44; and analyze the effect of immunosuppressor drugs Cyclosporin A &#40;CyA&#41;&#44; Tacrolimus &#40;Tac&#41;&#44; Sirolimus &#40;Siro&#41;&#44; Azathioprine &#40;Aza&#41; and Mofetil Mycophenolate on this complication&#46; Methods&#58; Gingival overgrowth presence and severity was classified&#44; and the impact of immunosuppressor drugs&#44; age&#44; oral hygiene&#44; verapamil and nifedipine on this condition was analyzed by multiple logistic regression&#46; Results&#58; 172 KT pts&#46; were examined&#59; 137 used CyA&#44; 25 Tac&#44; 6 Sirolimus&#44; 107 Aza and 56 MMF&#46; Gingival overgrowth prevalence was 59&#46;1&#37; on CyA&#44; 12&#46;0&#37; on Tac&#44; and 16&#46;7&#37; on Sirolimus&#46; CyA odds ratio &#40;OR&#41; 15&#46;2&#44; age <45 or 5 6 and poor oral hygiene 3 2 increased aza 0 05 mmf 03 decreased go prevalence conclusions: effect was a significant protection against in this group of kt patients</45>"
      ]
    ]
    "multimedia" => array:2 [
      0 => array:8 [
        "identificador" => "fig1"
        "etiqueta" => "Tab.  1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "41818078_t1_pag475.jpg"
            "Alto" => 272
            "Ancho" => 828
            "Tamanyo" => 51997
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Prevalence and severity of gingival overgrowth in groups using Cyclosporin A&#44; Tacrolimus&#44; or neither one"
        ]
      ]
      1 => array:8 [
        "identificador" => "fig2"
        "etiqueta" => "Tab.  2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "41818078_t2_pag476.jpg"
            "Alto" => 176
            "Ancho" => 828
            "Tamanyo" => 34494
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Multiple regression analysis&#44; risk factors for gingival overgrowth"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliography"
      "seccion" => array:1 [
        0 => array:1 [
          "bibliografiaReferencia" => array:24 [
            0 => array:3 [
              "identificador" => "bib1"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Danovitch GM. Immunosuppressive medications and protocols for kidney transplantation. En: Davinovitch GM, editor. Handbook of Kidney transplantation. Fourth edition, Philadelphia USA: Lippincott Williams & Wilkins; 2005;72-134."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib2"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "De la Rosa GE, Mondragón PA, Irigoyen CME, Bustamante RMA. Oral lesions in a group of kidney transplant patients. Med Oral Patol Oral Cir Bucal 2005;10:196-204.  <a href="http://www.ncbi.nlm.nih.gov/pubmed/15876960" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib3"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Al-Mohaya MA, Darwazeh AM, Bin-Salih S, Al-Khudair W. Oral lesions in Saudi renal transplant patients. Saudi J Kidney Dis Transpl 2009;20:20-9.  <a href="http://www.ncbi.nlm.nih.gov/pubmed/19112215" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib4"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Pernu HE, Pernu LMH, Huttunen KRH, Nieminen PA, Knuuttila MLE. Gingival overgrowth among renal transplant recipients related to immunosuppressive"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib5"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "medication and possible local background factors. J Periodontol 1992;63:548-53.  <a href="http://www.ncbi.nlm.nih.gov/pubmed/1625155" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib6"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Chae H-J, Ha M-S, Yun D-H, Pae H-O, Chung H-T, Chae S-W, et al. Mechanism of cyclosporine-induced overgrowth in gingiva. J Dent Res 2006;85:515-9.  <a href="http://www.ncbi.nlm.nih.gov/pubmed/16723647" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib7"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Costa FO, Ferreira SD, Cota LO, Costa JE, Aguilar MA. Prevalence, severity, and risk variables associated with gingival overgrowth in renal transplant subjects treated under tacrolimus or cyclosporin regimens. J Periodontol 2006;77:969-75.  <a href="http://www.ncbi.nlm.nih.gov/pubmed/16734570" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib8"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Cota LO, Oliveira AP, Costa JE, Cortelli SC, Costa FO. Gingival status of Brazilian renal transplant recipients under sirolimus-based regimens. J Periodontol 2008;9:2060-8."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib9"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Silness J, Loe H. Periodontal disease in pregnancy: correlation between oral hygiene and periodontal condition. Acta Odontol Scand 1964;22;131-5."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Somacarrera ML, Hernández G, Acero J, Moskow BS. Factors related to the incidence and severity of cyclosporin-induced gingival overgrowth in transplant patients. A longitudinal study. J Periodontol 1994;65:671-5.  <a href="http://www.ncbi.nlm.nih.gov/pubmed/7608843" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib11"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Seymour RA, Ellis JS, Thomanson JM. Risk factors for drug-induced gingival overgrowth. J Clin Periodontol 2000;27:217-23.  <a href="http://www.ncbi.nlm.nih.gov/pubmed/10783833" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib12"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Ellis JS, Seymour RA, Taylor JJ, Thomason JM. Prevalence of gingival overgrowth in transplant patients immunosuppressed with tacrolimus. J Clin Periodontol 2004;31:126-31.  <a href="http://www.ncbi.nlm.nih.gov/pubmed/15016038" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib13"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Sekiguchi RT, Paixão CG, Saraiva L, Romito GA, Pannuti CM, Lotufo RFM. Incidence of tacrolimus-induced gingival overgrowth in the absence of calcium channel blockers; a short-term study. J Clin Periodontol 2007;34:545-50.  <a href="http://www.ncbi.nlm.nih.gov/pubmed/17433046" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib14"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Thomason JM, Seymour RA, Ellis JS. Risk factors for gingival overgrowth in patients medicated with ciclosporin in the absence of calcium channel blockers. J Clin Periodontol 2005;32:273-9.  <a href="http://www.ncbi.nlm.nih.gov/pubmed/15766370" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib15"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Cara CJ, Pena AS, Sans M, Rodrigo L, Guerrero-Esteo M, Hinojosa J, et al. Reviewing the mechanism of action of thiopurine drugs: towards a new paradigm in clinical practice. Med Sci Monit 2004;10:RA247-54.  <a href="http://www.ncbi.nlm.nih.gov/pubmed/15507865" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib16"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Schachner T, Heiss S, Zipponi D, Tzankov A, Bernecker O, Kroell A, et al. Perivascular treatment with azathioprine reduces neointimal hyperplasia in experimental vein grafts. Heart Surg Forum 2006;9:E515-7.  <a href="http://www.ncbi.nlm.nih.gov/pubmed/16401538" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib17"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Allison AC, Eugui EM. Mechanisms of action of mycophenolate mofetil in preventing acute and chronic allograft rejection. Transplantation 2005;15:S181-90."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib18"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Naesens M, Kuypers DR, Sarwal M. Calcineurin inhibitor nephrotoxicity. Clin J Am Soc Nephrol 2009;4:481-508.  <a href="http://www.ncbi.nlm.nih.gov/pubmed/19218475" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib19"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Bravo Y, Quiroz Y, Ferrebuz A, Vaziri ND, Rodríguez-Iturbe B. Mycophenolate mofetil administration reduces renal inflammation, oxidative stress, and arterial pressure in rats with lead-induced hypertension. Am J Physiol Renal Physiol 2007;293:F616-23.  <a href="http://www.ncbi.nlm.nih.gov/pubmed/17567935" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib20"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Walsh M, James M, Jayne D, Tonelli M, Manns BJ, Hemmelgarn BR. Mycophenolate mofetil for induction therapy of lupus nephritis: A systematic review and meta-analysis. Clin J Am Soc Nephrol 2007;2:968-75.  <a href="http://www.ncbi.nlm.nih.gov/pubmed/17702723" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib21"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Boraty¿ska M, Radwan-Oczko M, Falkiewicz K, Klinger M, Szyber P. Gingival overgrowth in kidney transplant recipients treated with cyclosporine and its relationship with chronic graft nephropathy. Transplant Proc 2003;35:2238-40.  <a href="http://www.ncbi.nlm.nih.gov/pubmed/14529900" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib22"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Cezário ES, Cota LO, Ferreira SD, Siqueira FM, Soares RV, Zenóbio EG, Costa FO. Gingival overgrowth in renal transplant subjects medicated with tacrolimus in the absence of calcium channel blockers. Transplantation 2008;85:232-6.  <a href="http://www.ncbi.nlm.nih.gov/pubmed/18212628" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib23"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Hernández G, Arriba L, Frías MC, de la Marroca JC, Vicente JC, Jiménez C, et al. Conversion from cyclosporin A to tacrolimus as a non-surgical alternative to reduce gingival enlargement: a preliminary case series. J Periodontol 2003;74:1816-23.  <a href="http://www.ncbi.nlm.nih.gov/pubmed/14974825" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib24"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Nassar CA, Nassar PO, Andia DC, Guimarães MR, Spolidorio LC. The effects of up to 240 days of tacrolimus therapy on the gingival tissues of rats- a morphological evaluation. Oral Dis 2008;14:67-72.  <a href="http://www.ncbi.nlm.nih.gov/pubmed/18173451" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/20132514/0000002900000005/v0_201502091625/X2013251409003711/v0_201502091626/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "35444"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Short Originals"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/20132514/0000002900000005/v0_201502091625/X2013251409003711/v0_201502091626/en/P-E-S-A418-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251409003711?idApp=UINPBA000064"
]
Article information
ISSN: 20132514
Original language: English
The statistics are updated each day
Year/Month Html Pdf Total
2024 November 3 7 10
2024 October 67 57 124
2024 September 55 45 100
2024 August 70 61 131
2024 July 55 38 93
2024 June 66 46 112
2024 May 63 35 98
2024 April 74 40 114
2024 March 62 23 85
2024 February 59 37 96
2024 January 81 29 110
2023 December 65 24 89
2023 November 71 26 97
2023 October 83 44 127
2023 September 51 33 84
2023 August 46 22 68
2023 July 55 30 85
2023 June 98 26 124
2023 May 81 40 121
2023 April 89 22 111
2023 March 80 27 107
2023 February 51 21 72
2023 January 56 18 74
2022 December 68 26 94
2022 November 47 40 87
2022 October 42 31 73
2022 September 85 47 132
2022 August 65 50 115
2022 July 55 56 111
2022 June 71 41 112
2022 May 54 48 102
2022 April 63 46 109
2022 March 70 68 138
2022 February 51 58 109
2022 January 53 59 112
2021 December 77 58 135
2021 November 55 41 96
2021 October 80 46 126
2021 September 63 44 107
2021 August 58 43 101
2021 July 71 40 111
2021 June 80 28 108
2021 May 68 36 104
2021 April 132 19 151
2021 March 79 29 108
2021 February 95 19 114
2021 January 70 14 84
2020 December 65 20 85
2020 November 39 11 50
2020 October 40 15 55
2020 September 23 13 36
2020 August 51 6 57
2020 July 36 13 49
2020 June 44 11 55
2020 May 57 10 67
2020 April 47 15 62
2020 March 35 13 48
2020 February 58 31 89
2020 January 61 24 85
2019 December 56 23 79
2019 November 53 16 69
2019 October 35 7 42
2019 September 39 17 56
2019 August 29 14 43
2019 July 60 28 88
2019 June 51 10 61
2019 May 38 19 57
2019 April 86 30 116
2019 March 48 23 71
2019 February 27 17 44
2019 January 22 18 40
2018 December 66 26 92
2018 November 77 13 90
2018 October 93 16 109
2018 September 74 13 87
2018 August 27 10 37
2018 July 34 11 45
2018 June 41 11 52
2018 May 31 8 39
2018 April 45 12 57
2018 March 38 4 42
2018 February 43 8 51
2018 January 38 5 43
2017 December 39 8 47
2017 November 59 11 70
2017 October 42 5 47
2017 September 26 9 35
2017 August 33 9 42
2017 July 23 4 27
2017 June 39 17 56
2017 May 31 16 47
2017 April 27 10 37
2017 March 45 9 54
2017 February 33 5 38
2017 January 41 8 49
2016 December 68 7 75
2016 November 63 8 71
2016 October 97 13 110
2016 September 112 2 114
2016 August 205 6 211
2016 July 149 10 159
2016 June 154 0 154
2016 May 176 0 176
2016 April 126 0 126
2016 March 119 0 119
2016 February 116 0 116
2016 January 122 0 122
2015 December 160 0 160
2015 November 119 0 119
2015 October 89 0 89
2015 September 73 0 73
2015 August 57 0 57
2015 July 49 0 49
2015 June 34 0 34
2015 May 57 0 57
2015 April 5 0 5
Show all

Follow this link to access the full text of the article

Idiomas
Nefrología (English Edition)