Statistics

 array:21 [
  "pii" => "X2013251411000071"
  "issn" => "20132514"
  "doi" => "10.3265/Nefrologia.pre2011.Jul.11099"
  "estado" => "S300"
  "fechaPublicacion" => "2011-11-01"
  "documento" => "article"
  "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
  "subdocumento" => "fla"
  "cita" => "Nefrologia (English Version). 2011;31:756-7"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 4692
    "formatos" => array:3 [
      "EPUB" => 343
      "HTML" => 3819
      "PDF" => 530
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:17 [
      "pii" => "X0211699511000074"
      "issn" => "02116995"
      "doi" => "10.3265/Nefrologia.pre2011.Jul.11099"
      "estado" => "S300"
      "fechaPublicacion" => "2011-11-01"
      "documento" => "article"
      "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
      "subdocumento" => "fla"
      "cita" => "Nefrologia. 2011;31:756-7"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 5896
        "formatos" => array:3 [
          "EPUB" => 291
          "HTML" => 4999
          "PDF" => 606
        ]
      ]
      "es" => array:9 [
        "idiomaDefecto" => true
        "titulo" => "Patrón epidemiológico inusual en un paciente trasplantado renal con infección por VIH y sarcoma de Kaposi. Resolución tras tratamiento con sirolimus"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "756"
            "paginaFinal" => "757"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Unusual epidemiological pattern in kidney transplant patient with HIV and Kaposi¿s sarcoma. Resolution after sirolimus therapy"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "L. Calle, A. Mazuecos, T. García Álvarez, F. Guerrero, A. Moreno, R. Collantes, M. Rivero"
            "autores" => array:7 [
              0 => array:2 [
                "Iniciales" => "L."
                "apellidos" => "Calle"
              ]
              1 => array:2 [
                "Iniciales" => "A."
                "apellidos" => "Mazuecos"
              ]
              2 => array:2 [
                "Iniciales" => "T."
                "apellidos" => "García Álvarez"
              ]
              3 => array:2 [
                "Iniciales" => "F."
                "apellidos" => "Guerrero"
              ]
              4 => array:2 [
                "Iniciales" => "A."
                "apellidos" => "Moreno"
              ]
              5 => array:2 [
                "Iniciales" => "R."
                "apellidos" => "Collantes"
              ]
              6 => array:2 [
                "Iniciales" => "M."
                "apellidos" => "Rivero"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "X2013251411000071"
          "doi" => "10.3265/Nefrologia.pre2011.Jul.11099"
          "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/X2013251411000071?idApp=UINPBA000064"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699511000074?idApp=UINPBA000064"
      "url" => "/02116995/0000003100000006/v0_201502091400/X0211699511000074/v0_201502091401/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:17 [
    "pii" => "X2013251411000063"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.pre2011.Aug.11033"
    "estado" => "S300"
    "fechaPublicacion" => "2011-11-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia (English Version). 2011;31:757-8"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 4095
      "formatos" => array:3 [
        "EPUB" => 299
        "HTML" => 3256
        "PDF" => 540
      ]
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "titulo" => "Acute renal failure secondary to sodium and water depletion due to diarrhoea plus acetazolamide"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "757"
          "paginaFinal" => "758"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Fracaso renal agudo secundario a depleción hidrosalina por diarrea más acetazolamida"
        ]
      ]
      "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" => "11033_108_25088_en_11033_t1.jpg"
              "Alto" => 502
              "Ancho" => 600
              "Tamanyo" => 134930
            ]
          ]
          "descripcion" => array:1 [
            "en" => "Evolution of laboratory parameters"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "M. Polaina Rusillo, J. Borrego Hinojosa, A. Liébana Cañada"
          "autores" => array:3 [
            0 => array:2 [
              "Iniciales" => "M."
              "apellidos" => "Polaina Rusillo"
            ]
            1 => array:2 [
              "Iniciales" => "J."
              "apellidos" => "Borrego Hinojosa"
            ]
            2 => array:2 [
              "Iniciales" => "A."
              "apellidos" => "Liébana Cañada"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X0211699511000066"
        "doi" => "10.3265/Nefrologia.pre2011.Aug.11033"
        "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/X0211699511000066?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251411000063?idApp=UINPBA000064"
    "url" => "/20132514/0000003100000006/v0_201502091623/X2013251411000063/v0_201502091623/en/main.assets"
  ]
  "itemAnterior" => array:17 [
    "pii" => "X201325141100008X"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.pre2011.Jun.10976"
    "estado" => "S300"
    "fechaPublicacion" => "2011-11-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia (English Version). 2011;31:754-6"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 5529
      "formatos" => array:3 [
        "EPUB" => 339
        "HTML" => 4631
        "PDF" => 559
      ]
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "titulo" => "Fulminant oligo-secretory multiple myeloma"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "754"
          "paginaFinal" => "756"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Mieloma múltiple oligosecretor fulminante"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig1"
          "etiqueta" => "Fig. 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "copyright" => "Elsevier España"
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "10976_108_25080_en_10976_f1.jpg"
              "Alto" => 461
              "Ancho" => 600
              "Tamanyo" => 130630
            ]
          ]
          "descripcion" => array:1 [
            "en" => "Chest x-ray obtained upon patient hospitalisation"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "M. Heras, J. Izquierdo, A. Saiz, J. Hernández, J.A. Queizan, J. González, M.J. Fernández-Reyes, R. Sánchez"
          "autores" => array:8 [
            0 => array:2 [
              "Iniciales" => "M."
              "apellidos" => "Heras"
            ]
            1 => array:2 [
              "Iniciales" => "J."
              "apellidos" => "Izquierdo"
            ]
            2 => array:2 [
              "Iniciales" => "A."
              "apellidos" => "Saiz"
            ]
            3 => array:2 [
              "Iniciales" => "J."
              "apellidos" => "Hernández"
            ]
            4 => array:2 [
              "Iniciales" => "J.A."
              "apellidos" => "Queizan"
            ]
            5 => array:2 [
              "Iniciales" => "J."
              "apellidos" => "González"
            ]
            6 => array:2 [
              "Iniciales" => "M.J."
              "apellidos" => "Fernández-Reyes"
            ]
            7 => array:2 [
              "Iniciales" => "R."
              "apellidos" => "Sánchez"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X0211699511000082"
        "doi" => "10.3265/Nefrologia.pre2011.Jun.10976"
        "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/X0211699511000082?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X201325141100008X?idApp=UINPBA000064"
    "url" => "/20132514/0000003100000006/v0_201502091623/X201325141100008X/v0_201502091623/en/main.assets"
  ]
  "en" => array:11 [
    "idiomaDefecto" => true
    "titulo" => "Unusual epidemiological pattern in kidney transplant patient with HIV and Kaposi's sarcoma. Resolution after sirolimus therapy"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "756"
        "paginaFinal" => "757"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "L. Calle, A. Mazuecos, T. García Álvarez, F. Guerrero, A. Moreno, R. Collantes, M. Rivero"
        "autores" => array:7 [
          0 => array:3 [
            "Iniciales" => "L."
            "apellidos" => "Calle"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          1 => array:4 [
            "Iniciales" => "A."
            "apellidos" => "Mazuecos"
            "email" => array:1 [
              0 => "mauxiliadora&#46;mazuecos&#46;sspa&#64;juntadeandalucia&#46;es"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
          2 => array:3 [
            "Iniciales" => "T."
            "apellidos" => "Garc&#237;a &#193;lvarez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
          3 => array:3 [
            "Iniciales" => "F."
            "apellidos" => "Guerrero"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "affc"
              ]
            ]
          ]
          4 => array:3 [
            "Iniciales" => "A."
            "apellidos" => "Moreno"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
          5 => array:3 [
            "Iniciales" => "R."
            "apellidos" => "Collantes"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
          6 => array:3 [
            "Iniciales" => "M."
            "apellidos" => "Rivero"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:3 [
          0 => array:3 [
            "entidad" => "Servicio de Nefrología, Hospital Puerta del Mar Cádiz,   "
            "etiqueta" => "<span class="elsevierStyleSup">a</span>"
            "identificador" => "affa"
          ]
          1 => array:3 [
            "entidad" => "Servicio de Nefrología, Hospital Puerta del Mar, Cádiz,   "
            "etiqueta" => "<span class="elsevierStyleSup">b</span>"
            "identificador" => "affb"
          ]
          2 => array:3 [
            "entidad" => "Servicio de Medicina Interna, Hospital Puerta del Mar, Cádiz,   "
            "etiqueta" => "<span class="elsevierStyleSup">c</span>"
            "identificador" => "affc"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Patr&#243;n epidemiol&#243;gico inusual en un paciente trasplantado renal con infecci&#243;n por VIH y sarcoma de Kaposi&#46; Resoluci&#243;n tras tratamiento con sirolimus"
      ]
    ]
    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">To the Editor&#44; </span></p><p class="elsevierStylePara">Kaposi&#8217;s sarcoma &#40;KS&#41; is associated with human herpes virus 8 &#40;HHV-8&#41;&#44; although&#44; alone&#44; HHV-8 is not a major risk factor&#46; Situations that affect immunity&#44; such as infection from human immunodeficiency virus &#40;HIV&#41; or immunosuppressant treatment in solid organ transplant &#40;SOT&#41; patients&#44; markedly increase risk&#46;<span class="elsevierStyleSup">1&#44;2</span> KS in SOT patients tends to occur within the first few months post-transplant&#46;<span class="elsevierStyleSup">1&#44;3</span> A high CD4 lymphocyte count and high-activity anti-retroviral therapy &#40;HAART&#41; both significantly reduce the risk in patients with HIV&#46;<span class="elsevierStyleSup">2&#44;3</span></p><p class="elsevierStylePara">Proliferation signal inhibitors &#40;PSI&#41; inhibit tumour angiogenesis by reducing the production of vascular endothelial growth factor &#40;VEGF&#41; and its Flk-1&#47;KDR receptor&#46; The VEGF system plays a central role in the development of KS&#44; and so the effect of PSI is particularly relevant&#46; The results observed in SOT with KS after converting to PSI demonstrate this relationship&#44; and these drugs are currently the primary therapeutic option&#46;<span class="elsevierStyleSup">1</span> In KS associated with HIV&#44; the first line of treatment is controlling the HIV with HAART&#44; and the usefulness of PSI is still being researched&#46;<span class="elsevierStyleSup">2</span> Here we present the case of an HIV patient with a kidney transplant &#40;KT&#41; that developed KS&#46;</p><p class="elsevierStylePara">A 59-year old male infected with HIV &#40;by sexual transmission&#41; that was well controlled with HAART received a KT in May 2001&#46; He then continued treatment with HAART&#44; always maintaining a negative viral load and CD4&#62;200 cells&#47;&#181;l&#46; The immunosuppressant treatment consisted of steroids&#44; mycophenolate&#44; and tacrolimus&#46; The mycophenolate was suspended in January 2003 due to haematological intolerance&#46; In august 2003&#44; we performed a biopsy due to progressive deterioration of renal function and the patient was diagnosed with chronic nephropathy&#46;</p><p class="elsevierStylePara">In February 2010&#44; purple nodular lesions appeared on the patient&#8217;s left arm&#44; leading to the histopathological diagnosis of KS with intense immunohistochemical expression for CD31&#44; CD34&#44; and HHV-8&#46; An analysis of the extent of the disease ruled out visceral involvement&#46; Blood PCR analysis was negative for cytomegalovirus &#40;CMV&#41;&#44; Epstein-Barr virus HHV-6&#44; HHV-7&#44; and HHV-8&#44; with positive HHV-8 serology &#40;IgG-IFI&#41;&#46; At this moment the patient already had creatinine levels nearing 4&#46;5mg&#47;dl due to the chronic nephropathy&#46; We decided to significantly reduce the tacrolimus prescription &#40;to 3-4ng&#47;ml&#41; and start treatment with sirolimus &#40;at 4-6ng&#47;ml&#46; We did not completely remove the tacrolimus treatment for fear of poor tolerance to PSI due to renal failure&#46; Renal function continued to deteriorate&#44; and we recommenced dialysis in November 2010&#44; suspending tacrolimus&#46; We continued sirolimus treatment at low doses until the KS was resolved in Match 2011&#46; The patient currently continues on dialysis with a complete remission of all lesions&#46;</p><p class="elsevierStylePara">Our patient developed KS very late &#40;9 years post-KT&#41; and in spite of a good control of the HIV infection&#46; He had several different risk factors &#40;HHV-8&#44; HIV&#44; immunosuppressant treatment&#41; that were able to act synergistically&#44; favouring the development of the tumour with an atypical epidemiological pattern&#46; Given the experience published regarding HIV-negative SOT&#44; we believe that it was the conversion to sirolimus rather than the decreased tacrolimus levels that caused the favourable evolution of the KS&#46; Only three other cases of KS in HIV-positive SOT &#40;two KT&#44; one live transplant&#41; have been communicated with a positive response following conversion to PSI&#46;<span class="elsevierStyleSup">4&#44;5</span> However&#44; these cases were not described in detail since they made up part of a general series on SOT in patients with HIV&#46;</p><p class="elsevierStylePara">Although the most extensive treatment in HIV-positive SOT is the combination of MMF and anti-calcineurinics&#44; good results have also been obtained with protocols based on PSI&#46;<span class="elsevierStyleSup">5&#44;6</span> Additionally&#44; PSI appear to have beneficial effects on the replication of HIV&#46;<span class="elsevierStyleSup">5</span> We believe that a treatment regimen based on PSI could be the therapy of choice as the primary immunosuppressant following KT in transplant recipients with HIV infection and risk factors for KS &#40;male&#44; sexual practices&#44; ethnicity&#44; HHV-8 positive&#41;&#44; as long as contraindications do not exist&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span></p><p class="elsevierStylePara">The authors have no conflicts of interest to declare&#46;</p>"
    "pdfFichero" => "P1-E528-S3221-A11099-EN.pdf"
    "tienePdf" => true
    "PalabrasClave" => array:1 [
      "en" => array:4 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec439549"
          "palabras" => array:1 [
            0 => "Sirolimus"
          ]
        ]
        1 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec439552"
          "palabras" => array:1 [
            0 => "Kaposi&#180;s sarcoma"
          ]
        ]
        2 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec439554"
          "palabras" => array:1 [
            0 => "HIV infection"
          ]
        ]
        3 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec439556"
          "palabras" => array:1 [
            0 => "Transplantation"
          ]
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliography"
      "seccion" => array:1 [
        0 => array:1 [
          "bibliografiaReferencia" => array:6 [
            0 => array:3 [
              "identificador" => "bib1"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Campistol JM, Schena FP. Kaposi¿s sarcoma in renal transplant recipients-the impact of proliferation signal inhibitors. Nephrol Dial Transplant 2007;22(Suppl 1):i17-i22. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17456614" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib2"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Bower M, Collins S, Cottrill C, Cwynarski K, Montoto S. British HIV Association guidelines for HIV-associated malignancies 2008. HIV Med 2008;9:336-88. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18705759" 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" => "Serraino D, Angeletti C, Carrieri MA, Longo B, Piche M. Kaposi¿s sarcoma in transplant and HIV-infected patients: an epidemiologic study in Italy and France. Transplantation 2005;80:1699-704."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib4"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Stock PG, Barin B, Murphy B, Hanto D, Diego J, et al. Outcomes of kidney transplantation in HIV-infected recipients. N Engl J Med 2010;363:2004-14. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21083386" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib5"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Di Benedetto F, Di Sandro S, De Ruvo N, Montalti R, Ballarin R. First report on a series of HIV patients undergoing rapamycin monotherapy after liver transplantation. Transplantation 2010;89:733-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20048692" 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" => "Kumar MS, Sierka DR, Damask AM, Fyfe B, McAlack RF. Safety and success of kidney transplantation and concomitant immunosuppression in HIV-positive patients. Kidney Int 2005;67:1622-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15780120" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/20132514/0000003100000006/v0_201502091623/X2013251411000071/v0_201502091623/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "35437"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Letters to the Editor - Brief Case Reports"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003100000006/v0_201502091623/X2013251411000071/v0_201502091623/en/P1-E528-S3221-A11099-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251411000071?idApp=UINPBA000064"
]