array:21 [
  "pii" => "X2013251412001669"
  "issn" => "20132514"
  "doi" => "10.3265/Nefrologia.pre2012.Jun.11571"
  "estado" => "S300"
  "fechaPublicacion" => "2012-07-01"
  "documento" => "article"
  "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
  "subdocumento" => "fla"
  "cita" => "Nefrologia (English Version). 2012;32:427-31"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 5423
    "formatos" => array:3 [
      "EPUB" => 306
      "HTML" => 4365
      "PDF" => 752
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:17 [
      "pii" => "X0211699512001661"
      "issn" => "02116995"
      "doi" => "10.3265/Nefrologia.pre2012.Jun.11571"
      "estado" => "S300"
      "fechaPublicacion" => "2012-07-01"
      "documento" => "article"
      "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
      "subdocumento" => "fla"
      "cita" => "Nefrologia. 2012;32:427-31"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 7217
        "formatos" => array:3 [
          "EPUB" => 317
          "HTML" => 6265
          "PDF" => 635
        ]
      ]
      "es" => array:10 [
        "idiomaDefecto" => true
        "titulo" => "Importancia del donante añoso como fuente de órganos válidos para el trasplante renal: ¿dónde está el límite?"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "427"
            "paginaFinal" => "431"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Importance of elderly donors as a source of valid organs for renal transplantation: where is the limit?"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => 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" => "11571_108_32287_es_11571_t1.jpg"
                "Alto" => 724
                "Ancho" => 600
                "Tamanyo" => 235876
              ]
            ]
            "descripcion" => array:1 [
              "es" => "Inmunosupresión y evolución de los injertos de donantes añosos"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Ana Fernández-Rodríguez, Roberto Marcén-Letosa, Cristina Galeano-Álvarez"
            "autores" => array:3 [
              0 => array:2 [
                "nombre" => "Ana"
                "apellidos" => "Fernández-Rodríguez"
              ]
              1 => array:2 [
                "nombre" => "Roberto"
                "apellidos" => "Marcén-Letosa"
              ]
              2 => array:2 [
                "nombre" => "Cristina"
                "apellidos" => "Galeano-Álvarez"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "X2013251412001669"
          "doi" => "10.3265/Nefrologia.pre2012.Jun.11571"
          "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/X2013251412001669?idApp=UINPBA000064"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699512001661?idApp=UINPBA000064"
      "url" => "/02116995/0000003200000004/v0_201502091347/X0211699512001661/v0_201502091347/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:17 [
    "pii" => "X2013251412001650"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.pre2012.Apr.11472"
    "estado" => "S300"
    "fechaPublicacion" => "2012-07-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia (English Version). 2012;32:432-8"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 7471
      "formatos" => array:3 [
        "EPUB" => 308
        "HTML" => 6368
        "PDF" => 795
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "titulo" => "Ischemic nephropathy ' pathogenesis and treatment"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "432"
          "paginaFinal" => "438"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Nefropatía isquémica: patogénesis y tratamiento"
        ]
      ]
      "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" => "11472_108_29486_en_11472_t1.jpg"
              "Alto" => 308
              "Ancho" => 600
              "Tamanyo" => 172793
            ]
          ]
          "descripcion" => array:1 [
            "en" => "Predictors of salvageability of ischemic nephropathy after revascularisation"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Marcin Adamczak, Andrzej Wiecek"
          "autores" => array:2 [
            0 => array:2 [
              "nombre" => "Marcin"
              "apellidos" => "Adamczak"
            ]
            1 => array:2 [
              "nombre" => "Andrzej"
              "apellidos" => "Wiecek"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X0211699512001653"
        "doi" => "10.3265/Nefrologia.pre2012.Apr.11472"
        "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/X0211699512001653?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251412001650?idApp=UINPBA000064"
    "url" => "/20132514/0000003200000004/v0_201502091610/X2013251412001650/v0_201502091610/en/main.assets"
  ]
  "itemAnterior" => array:17 [
    "pii" => "X2013251412001677"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.pre2012.Jun.11576"
    "estado" => "S300"
    "fechaPublicacion" => "2012-07-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia (English Version). 2012;32:419-26"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 11674
      "formatos" => array:3 [
        "EPUB" => 332
        "HTML" => 10517
        "PDF" => 825
      ]
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "titulo" => "About the discrepancies between consensus documents, clinical practice guidelines, and legal regulations in the treatment of type 2 diabetes"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "419"
          "paginaFinal" => "426"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "A propósito de las discrepancias entre documentos de consenso, guías de práctica clínica y normativa legal en el tratamiento de la diabetes tipo 2"
        ]
      ]
      "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" => "11576_16025_33456_en_t111576i.jpg"
              "Alto" => 884
              "Ancho" => 2186
              "Tamanyo" => 182581
            ]
          ]
          "descripcion" => array:1 [
            "en" => "Oral anti-diabetic drugs and their use in chronic kidney disease according to drug technical data sheets"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => " * GEENDIAB (Grupo español para el estudio de la nefropatía diabética) y REDINREN (Red de Investigacion Renal)., Alberto Martínez-Castelao*, José L. Górriz*, Eva Sola, Carlos Morillas, Ana Jover, Francisco Coronel, Juan Navarro-González*, Fernando De Álvaro*"
          "autores" => array:9 [
            0 => array:1 [
              "apellidos" => "* GEENDIAB (Grupo español para el estudio de la nefropatía diabética) y REDINREN (Red de Investigacion Renal)."
            ]
            1 => array:2 [
              "nombre" => "Alberto"
              "apellidos" => "Martínez-Castelao*"
            ]
            2 => array:2 [
              "nombre" => "José L."
              "apellidos" => "Górriz*"
            ]
            3 => array:2 [
              "nombre" => "Eva"
              "apellidos" => "Sola"
            ]
            4 => array:2 [
              "nombre" => "Carlos"
              "apellidos" => "Morillas"
            ]
            5 => array:2 [
              "nombre" => "Ana"
              "apellidos" => "Jover"
            ]
            6 => array:2 [
              "nombre" => "Francisco"
              "apellidos" => "Coronel"
            ]
            7 => array:2 [
              "nombre" => "Juan"
              "apellidos" => "Navarro-González*"
            ]
            8 => array:2 [
              "nombre" => "Fernando"
              "apellidos" => "De Álvaro*"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X021169951200167X"
        "doi" => "10.3265/Nefrologia.pre2012.Jun.11576"
        "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/X021169951200167X?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251412001677?idApp=UINPBA000064"
    "url" => "/20132514/0000003200000004/v0_201502091610/X2013251412001677/v0_201502091610/en/main.assets"
  ]
  "en" => array:12 [
    "idiomaDefecto" => true
    "titulo" => "Importance of elderly donors as a source of valid organs for renal transplantation: where is the limit?"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "427"
        "paginaFinal" => "431"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "Ana Fernández-Rodríguez, Roberto Marcén-Letosa, Cristina Galeano-Álvarez"
        "autores" => array:3 [
          0 => array:4 [
            "nombre" => "Ana"
            "apellidos" => "Fernández-Rodríguez"
            "email" => array:1 [
              0 => "afernandezr.hrc@salud.madrid.org"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Roberto"
            "apellidos" => "Marc&#233;n-Letosa"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Cristina"
            "apellidos" => "Galeano-&#193;lvarez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:3 [
            "entidad" => "Servicio de Nefrología, Hospital Universitario Ramón y Cajal, Madrid,   "
            "etiqueta" => "<span class="elsevierStyleSup">a</span>"
            "identificador" => "affa"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Importancia del donante a&#241;oso como fuente de &#243;rganos v&#225;lidos para el trasplante renal&#58; &#191;d&#243;nde est&#225; el l&#237;mite&#63;"
      ]
    ]
    "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" => "11571_16025_33233_en_11571_t1.jpg"
            "Alto" => 2590
            "Ancho" => 2181
            "Tamanyo" => 264397
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Immunosuppression and evolution of organs from elderly donors"
        ]
      ]
    ]
    "textoCompleto" => "<p class="elsevierStylePara">In the current issue of Nefrolog&#237;a<span class="elsevierStyleItalic">&#44; </span>Dr Gonzalez Roncero et al&#44;<span class="elsevierStyleSup">1</span> all of whom are members of a study group of thirteen transplant hospitals&#44; present their results regarding the long-term evolution of 133 kidney grafts from expanded criteria donors&#46;</p><p class="elsevierStylePara">In this study&#44; immunosuppression was used with two doses of daclizumab&#44; mycophenolate mofetil&#44; normal steroid doses&#44; and late introduction of tacrolimus&#46; They present the 5-year evolution of patients that reached one year of graft survival in a study that initially used a prospective design&#44; whose results were published in 2008 in this same journal&#46; The continuation of follow-up with these patients is of great interest&#44; since it is a multi-centre study with an originally prospective study design and shows 5-year results&#44; information that is not commonly presented in the medical literature for these types of donors&#46;</p><p class="elsevierStylePara">In addition&#44; this article is of special application in Spain&#44; where the age and comorbidity of donors has increased substantially in the past two decades&#44; donor age increasing from 34 years in 1992 to 57 years in 2010&#46; Currently&#44; more than 50&#37; of donors are older than 60 years&#44; and many of them have associated comorbidity&#44; such as diabetes or arterial hypertension&#46;<span class="elsevierStyleSup">2</span></p><p class="elsevierStylePara">As a consequence of these changes in donor characteristics&#44; the scenario surrounding kidney transplants has shifted notably in recent decades&#46;</p><p class="elsevierStylePara">At the end of the 1990&#8217;s and the start of the new millennium&#44; published studies focused primarily on two different aspects&#58; the indications for transplants in elderly recipients&#44; and the evolution of grafts in elderly recipients regardless of the age of the donor&#46;</p><p class="elsevierStylePara">The indications for kidney transplants in elderly renal failure patients on dialysis was established in a study &#40;among others&#41; by Wolfe et al&#44;<span class="elsevierStyleSup">3</span> which compared the mortality of recipients of standard organs&#44; those receiving marginal organs&#44; and those who remained on the kidney waiting list&#46; In their statistical analysis&#44; the authors concluded that the mean expected survival rate was 5 years higher in transplant recipients as compared to those who remained on the wait list&#46;<span class="elsevierStyleSup">3-5</span></p><p class="elsevierStylePara">In the analysis of the evolution of kidney transplants in elderly recipients&#44; regardless of the type of donor&#44; the article published by Waiser et al is especially interesting&#46; They evaluated the 8-year survival of 1269 patients&#44; 176 of which received kidneys from donors older than 55 years &#40;132 were placed in elderly recipients and 44 in young recipients&#41;&#46; The relative risk of graft loss after 8 years was 1&#46;97 times higher in young recipients than in recipients &#62;55 years&#46;<span class="elsevierStyleSup">6</span> The cause of graft loss in young patients was primarily acute rejection &#40;33&#46;7&#37;&#41; and chronic rejection &#40;24&#37;&#41;&#46;</p><p class="elsevierStylePara">Once the safety and efficacy of transplants in elderly recipients was established&#44; and it was shown that the primary cause of graft loss in these patients was death with a functioning transplant&#44; the majority of transplant teams expanded their criteria for organ donors under the &#8220;old for old&#8221; policy&#44; in which elderly recipients received organs from expanded criteria donors&#46; This policy is reasonable&#44; since organ survival is not so important in elderly recipients as in young recipients&#46;<span class="elsevierStyleSup">7-12</span></p><p class="elsevierStylePara">Graft survival rates are worse in expanded criteria kidneys due to structural changes in kidneys that come with age&#46; These alterations include glomerulosclerosis&#44; interstitial fibrosis&#44; tubular atrophy&#44; and vascular damage&#44; which make them more sensitive to ischaemia and reperfusion damage&#46; In addition&#44; they have a higher rate of acute tubular necrosis &#40;ATN&#41; than those of young donors&#44; and higher sensitivity to calcineurin inhibitor-related nephrotoxicity&#46; Furthermore&#44; these kidneys have worse renal function one month following transplantation&#44; donor age being the main risk factor for decreased glomerular filtration rate&#46;<span class="elsevierStyleSup">10-12</span></p><p class="elsevierStylePara">Experimental studies performed in rats have suggested that acute failure is more probable in older kidney transplants&#59; however&#44; these experimental data have produced contradictory results in human studies&#46;<span class="elsevierStyleSup">13-15</span></p><p class="elsevierStylePara">Other characteristics of elderly recipients include metabolic changes that can induce differences in the pharmacokinetics of immunosuppressants and other drugs&#44; more cardiovascular risk factors and immune system alterations&#44; making patients more susceptible to infections and tumours&#46;<span class="elsevierStyleSup">16&#44;17</span> In fact&#44; in the study by Gonzalez-Roncero et al<span class="elsevierStyleSup">1</span> previously mentioned&#44; 7 of the 10 deaths were due to tumours&#46;</p><p class="elsevierStylePara">All of these physiological changes in elderly donors and recipients have generated substantial interest in achieving optimal immunosuppression when organs are derived from elderly donors in all transplant recipient groups&#46;</p><p class="elsevierStylePara">In the majority of these studies&#44; induction therapy is used with early introduction of calcineurin inhibitors at lower doses than in standard donors&#44; or&#44; as in the case we are focusing on&#44; with calcineurin inhibitors starting a few days after transplantation&#46;<span class="elsevierStyleSup">1&#44;15&#44;18-26</span></p><p class="elsevierStylePara">Other groups have opted to avoid calcineurin inhibitors altogether&#44; using instead high induction doses with proliferation signal inhibitors or mycophenolate mofetil directly following transplantation&#46;<span class="elsevierStyleSup">27&#44;28</span></p><p class="elsevierStylePara">Unfortunately&#44; we lack prospective randomised studies that might definitively establish an optimal immunosuppression regimen in this group of donors&#47;recipients&#44; who require such a delicate equilibrium between immunosuppression and immunocompetence&#46; This is due to the fact that the majority of clinical trials have excluded elderly recipients in order to avoid the side effects associated with the characteristics of these recipients&#46;</p><p class="elsevierStylePara">Treatment protocols that do not include calcineurin inhibitors&#44; such as that described by Abrogast and Guba&#44;<span class="elsevierStyleSup">27&#44;28</span> may cause an excessive rate of acute rejection&#44; higher than 50&#37;&#46; This study&#8217;s protocol was based on high initial induction doses of thymoglobulin at 4mg&#47;kg&#47;day on day zero and two doses of basiliximab followed by high steroid and mycophenolate doses&#44; which did not reduce the rate of ATN or provide benefits in terms of mid-term patient or graft survival&#46;<span class="elsevierStyleSup">28</span></p><p class="elsevierStylePara">In protocols involving late introduction of calcineurin inhibitors &#40;which range between 3 and 7 days&#41;&#44; the rate of acute rejection is acceptable&#44; and graft and patient survival rates are adequate&#46;<span class="elsevierStyleSup">19&#44;20&#44;22&#44;25</span> In the study published in this issue&#44;<span class="elsevierStyleSup">1</span> the acute rejection rate was 13&#37;&#44; and patient and graft survival rates adjusted for patient death after one year of follow-up were 97&#46;7&#37; and 96&#46;1&#37;&#44; respectively&#44; some of the highest rates published in the medical literature&#46;<span class="elsevierStyleSup">20</span></p><p class="elsevierStylePara">One particularly interesting result of this study was the low rate of acute rejection when using two doses of daclizumab&#44; a drug that was initially designed for use in five doses&#44; which without a doubt has considerably decreased the initial costs of treatment for this condition&#44; without increasing the rate of acute rejection&#46;</p><p class="elsevierStylePara">In this study&#44; the results after 5 years were also good&#44; with patient survival at 93&#46;3&#37; and graft survival at 93&#46;8&#37; &#40;adjusted for patient death&#41;&#46; This could be due to close follow-up of patients in this study&#44; with a very strict control of cardiovascular risk factors&#44; since at the end of the follow-up period&#44; 92&#37; of patients received antihypertensive drugs&#44; 63&#37; statins&#44; 18&#46;4&#37; erythropoietin&#44; and 15&#37; oral anti-diabetics or insulin&#46; This very close clinical surveillance&#44; along with low doses and low blood levels of tacrolimus over the 5-year follow-up period&#44; undoubtedly contributed to the good results obtained&#46;</p><p class="elsevierStylePara">In our hospital&#44; we use a regimen based on induction with basiliximab in two doses&#44; early introduction of calcineurin inhibitors &#40;day &#43;1 post-transplant&#41; at one-half the normal dose&#44; and low target levels&#46; We analysed graft and patient survival in especially elderly donors &#40;older than 70 years&#41;&#46; These data were published by Galeano et al<span class="elsevierStyleSup">26</span> and showed an acute rejection rate &#40;8&#46;5&#37;&#41; and ATN of 38&#46;5&#37;&#46; Compared with donors aged 50-70 years&#44; very elderly donors do not show a higher rate of acute rejection or ATN&#46; Graft survival rates without adjusting for death are similar between recipients from donors aged 50-70 years and recipients from donors older than 70 years&#44; with evidently higher mortality rates in the group of older recipients&#46;<span class="elsevierStyleSup">26</span></p><p class="elsevierStylePara">The Table summarises the initial immunosuppression treatment&#44; donor and recipient age&#44; incidence of ATN&#44; incidence of acute rejection&#44; and patient and graft survival after 1 and 5 years in elderly recipients in selected articles&#46; It is evident in articles published in recent years that donor and recipient age is very advanced&#44; and is notably higher than in the article published in this issue&#46;<span class="elsevierStyleSup">1</span></p><p class="elsevierStylePara">In the studies by Foss&#44; Collini&#44; Favi&#44; and Galeano&#44;<span class="elsevierStyleSup">23-26</span> taking into account the advanced age of both donors and recipients&#44; patient and graft survival rates were adequate and&#44; in comparison to articles published at the start of the new millennium&#44; the mean age of donors and recipients has increased without having established an age limit for donors or recipients&#46;</p><p class="elsevierStylePara">The results from the three-year BENEFIT EXT study<span class="elsevierStyleSup">31 </span>were published recently&#44; in which belatacept administered with cyclosporine and mycophenolate mofetil resulted especially beneficial for improving glomerular filtration rates in recipients of organs from elderly donors&#46; There were no significant differences in the rate of acute rejection as compared to the control group&#44; which received cyclosporine&#44; mycophenolate&#44; and steroids&#46;</p><p class="elsevierStylePara">Without a doubt&#44; organ transplants from elderly donors require special treatment in the immediate postoperative period&#44; including minimal cold ischaemia time&#44; immunosuppression adjusted for donor&#47;recipient characteristics&#44; the highest possible number of HLA compatibilities&#44; and minimal use of calcineurin inhibitors&#46; This study shows the vital importance of continuing optimal treatment over time&#44; minimising the use of calcineurin inhibitors&#44; and proper control of cardiovascular risk factors&#46; The long-term benefits of belatacept in these patients remain to be established&#46;</p><p class="elsevierStylePara"><a href="grande&#47;11571&#95;16025&#95;33233&#95;en&#95;11571&#95;t1&#46;jpg" class="elsevierStyleCrossRefs"><img src="11571_16025_33233_en_11571_t1.jpg" alt="Immunosuppression and evolution of organs from elderly donors"></img></a></p><p class="elsevierStylePara">Table 1&#46; Immunosuppression and evolution of organs from elderly donors</p>"
    "pdfFichero" => "P1-E541-S3620-A11571-EN.pdf"
    "tienePdf" => true
    "multimedia" => array:1 [
      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" => "11571_16025_33233_en_11571_t1.jpg"
            "Alto" => 2590
            "Ancho" => 2181
            "Tamanyo" => 264397
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Immunosuppression and evolution of organs from elderly donors"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliography"
      "seccion" => array:1 [
        0 => array:1 [
          "bibliografiaReferencia" => array:31 [
            0 => array:3 [
              "identificador" => "bib1"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "González-Roncero FM, Gentil-Govantes MA, González-Molina M, Rivero M, Cantarell C, Alarcón A, et al. Evolución tardía del trasplante renal de donante y receptor añosos con una inmunosupresión inicial con daclizumab, mofetil-micofenolato e introducción retrasada de tacrolimus. Nefrologia 2012;32(4):xx-xx."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib2"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Organización Nacional de Trasplantes. Memorias - Datos de donación y trasplante renal de la ONT [varios años]. Available at:\u{A0}http://www.ont.es/infesp/Paginas/Memorias.aspx"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib3"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Wolfe RA,\u{A0}Ashby VB,\u{A0}Milford EL,\u{A0}Ojo AO,\u{A0}Ettenger RE,\u{A0}Agodoa LY, et al. Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation and recipients of a first cadaveric transplant. N Engl J Med 1999;341:1725-30. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10580071" 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" => "Ojo AO, Hanson JA, Meier-Kriesche H, Okechukwu CN, Wolfe RA, Leichtman AB, et al. Survival in recipients of marginal cadaveric donor kidney compared with other recipients and wait-listed transplant canditates. J Am Soc Nephrol 2001;12:589-97. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11181808" 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" => "McDonald S, Russ G. Survival of recipients of cadaveric kidney transplant with those receiving dialysis treatment in Austria and New Zeland, 1991-2001. Nephrol Dial Transplant 2002,17:2212-9."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib6"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Waiser J, Schreiber M, Budde K, Fritsche L,\u{A0}Böhler T,\u{A0}Hauser I,\u{A0}et al. Age-matching in renal tansplantation. Nephrol Dial Transplant 2000;15:696-700. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10809813" 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" => "Cohen B, Smits JM, Hase B, Persijn G,\u{A0}Vanrenterghem Y,\u{A0}Frei U. Expanding the donor pool to increase renal transplantation. Nephrol Dial Transplant 2005;20:34-41. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15522904" 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" => "Beckurts UTA, Stippel D, Pollok M, Arns W,\u{A0}Weber M,\u{A0}Hölscher AH. Single center experience with the old for old program for renal transplantation. Transplant Proc 2001;33:3779-80. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11750608" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib9"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Fritsche L, Hörstrup J, Budde K, Reinke P,\u{A0}Giessing M,\u{A0}Tullius S,\u{A0}et al. Old for old kidney allocation allows successful expansion of the donor and recipients pool. Am J Transplant 2003;3:1434-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/14525606" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Zhou XJ, Rakheja D, Yu X, Saxena R,\u{A0}Vaziri ND,\u{A0}Silva FG. Te ageing kidney. Kidney Int 2008;74:710-20. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18614996" 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" => "Feinfeld DA, Guzik H, Cavournis C, Lynn RI,\u{A0}Somer B,\u{A0}Aronson MK,\u{A0}et al. Sequential changes in renal fuction tests on the old: results from de Bronx Longitudinal Aging Study. J Am Geriatr Soc 1995;43:412-4. <a href="http://www.ncbi.nlm.nih.gov/pubmed/7706633" 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" => "Siddidi N, McBride MA, Hariaharan S. Similar risk profiles for postransplant dysfunction and long term graft faillure: UNOS/OPTN database analysis. Kidney Int 2004;65:1906-13. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15086934" 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" => "Reutzel-Selke A, Filatenov A, Jurische A, Denecke C,\u{A0}Martins PN,\u{A0}Pascher A,\u{A0}et al. Grafts from elderly donors elict a stronger immune response in the early period postransplantation. A study in a rat model. Transplant Proc 2005;37(1):382-3. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15808652" 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" => "Lim WH, Ghang S, Chadban S, Campbell S, Dent H, Russ GR,\u{A0}et al. Donor-recipient age matching improves years of graft function in deceased donor kidney transplantation. Nephrol Dial Transplant 2010;25(9):3082-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20736266" 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" => "Bodingbauer M, Pakrah B, Steininger R, Berlakovich G,\u{A0}Rockenschaub S,\u{A0}Wekerle T,\u{A0}et al. The advantage of allocating kidney from old cadaveric donors to old recipients. A single center experience. Clin Transplant 2006;20:471-5. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16842524" 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" => "Meier-Kriesche HU,\u{A0}Ojo A,\u{A0}Hanson J,\u{A0}Cibrik D,\u{A0}Lake K,\u{A0}Agodoa LY, et al. Increased immunosuppressive vulnerability in the elderly renal transplant recipients. Transplantation 2000;69:885-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10755545" 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" => "Trouillet I, Benito N, Cervera C, Rivas P,\u{A0}Cofán F,\u{A0}Almela M,\u{A0}et al. Infuence of age in renal transplant infections. Cases and control study. Transplantation 2005;80:989-92. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16249750" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib18"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Daniovicht GM, Gill J, Bunnapradist S. Immunosupression of the elderly kidney transplant recipient. Transplantation 2007;84(3):285-91. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17700150" 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" => "Emparan C, Wolters H, Laukotter M, Senninger N. Long term results of calcineurion free protocols with basiliximab induction in old to old programs. Transplant Proc 2004;36:2646-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15621113" 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" => "Gentil MA, Osuna A, Capdevilla L, Cantarell C,\u{A0}Pereira P,\u{A0}Mazuecos A,\u{A0}et al. Daclizumab en combinación con micofenolato mofetilo e introducción tardía de tacrolimus a dosis bajas, como opción terapéutica en la pareja donante-receptor añoso en trasplante renal. Nefrologia 2008;28(3):287-92. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18590495" 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" => "Smits JM, Persijn GG, Van Houwelingen HC, Claas FH,\u{A0}Frei U. Evaluation of the Eurotransplant Senior Program. The results of the first year. Am J Transplant 2002;2:664-70. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12201369" 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" => "Stratta RJ, Sudberg AK, Rohr R, Farney AC,\u{A0}Hartmann EL,\u{A0}Roskopf JA,\u{A0}el al. Optimal use the old donors and recipients in kidney transplantation. Surgery 2006;139:324-33. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16546496" 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" => "Foss A, Heldal K, Scott H, Foss S,\u{A0}Leivestad T,\u{A0}Jørgensen PF,\u{A0}et al. Kidneys from deceased donors more than 75 years perform acceptably after transplantation. Transplantation 2009;87:1437-41. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19461478" 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" => "Collini A, Kalmar P, Damo A, Ruggieri G,\u{A0}Carmellini M. Renal transplantation from very old donors. How far can we go? Transplantation 2009;87:1437-41."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib25"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Favi E, Gargiulo A, Spagnoletti G, Salerno MP,\u{A0}Silvestrini N,\u{A0}Valente I,\u{A0}et al. Induction with basiliximab plus thymoglobulin is effective and safe in old for old renal transplantation: Six months results of a prospective clinical study. Transplant Proc\u{A0}2010;42(4):1114-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20534237" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib26"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Galeano C, Marcén R, Jimenez S, Fernández Rodríguez A,\u{A0}Sosa H,\u{A0}Villafruela JJ,\u{A0}et al. Utilization of elderly kidney donors (>70 years) does not affect graf survival in medium term. Transplant Proc 2010;42:3935-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21168591" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib27"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Arbogast H, Huckelheim H, Shneeberger H, Illner WD,\u{A0}Tarabichi A,\u{A0}Fertmann J,\u{A0}et al. A calcineurin antagonist free induction/maintenance strategy for inmunossupresión in elderly recipients of renal allograft from elderly cadaver donors. Clin Transplant 2005;19:309-15. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15877790" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib28"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Guba M, Rentsch M, Wimmer CD, Uemueksuez A, Illner WD, Schönermarck U,\u{A0}et al. Calcineurin inhibitor avoidance in elderly renal allograft recipients using ATG y basiliximab combined with mycofenolate mofetil. Transpl Int 2008;21:637-45. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18282242" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib29"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Frei U, Noeldeke J, Machold-Fabrizzi V, Arbogast H,\u{A0}Margreiter R,\u{A0}Fricke L,\u{A0}et al. Prospective age maching in elderly kidney transplant recipients. A 5 years analysis of the Eurotransplant Senior Program. Am J Transplant 2008;8:50-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17973969" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib30"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Palomar R, Ruiz JC, Zubimendi JA, Cotorruelo JG,\u{A0}de Francisco AL,\u{A0}Rodrigo E, et al. Acute rejection in the early recipient: Influence of age in the outcome of kideny transplantation. Int Urol Nephrol 2002;33:145-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12090322" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib31"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Pestana JO, Griñó JM, Varenterghem Y, Becker T,\u{A0}Campistol JM,\u{A0}Florman S,\u{A0}et al. Three-year outcomes from Benefit-ext: a phase III study of belatacept versus cyclosporine in recipients of extended criteria donor kidneys. Am J Transplant 2012;12(3):630-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/22300431" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/20132514/0000003200000004/v0_201502091610/X2013251412001669/v0_201502091610/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "35428"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Editorial Comments"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003200000004/v0_201502091610/X2013251412001669/v0_201502091610/en/P1-E541-S3620-A11571-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251412001669?idApp=UINPBA000064"
]
Share
Journal Information

Statistics

Follow this link to access the full text of the article

Importance of elderly donors as a source of valid organs for renal transplantation: where is the limit?
Importancia del donante añoso como fuente de órganos válidos para el trasplante renal: ¿dónde está el límite?
Ana Fernández-Rodrígueza, Roberto Marcén-Letosaa, Cristina Galeano-Álvareza
a Servicio de Nefrología, Hospital Universitario Ramón y Cajal, Madrid,
Read
9298
Times
was read the article
2531
Total PDF
6767
Total HTML
Share statistics
 array:21 [
  "pii" => "X2013251412001669"
  "issn" => "20132514"
  "doi" => "10.3265/Nefrologia.pre2012.Jun.11571"
  "estado" => "S300"
  "fechaPublicacion" => "2012-07-01"
  "documento" => "article"
  "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
  "subdocumento" => "fla"
  "cita" => "Nefrologia &#40;English Version&#41;. 2012;32:427-31"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 5423
    "formatos" => array:3 [
      "EPUB" => 306
      "HTML" => 4365
      "PDF" => 752
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:17 [
      "pii" => "X0211699512001661"
      "issn" => "02116995"
      "doi" => "10.3265/Nefrologia.pre2012.Jun.11571"
      "estado" => "S300"
      "fechaPublicacion" => "2012-07-01"
      "documento" => "article"
      "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
      "subdocumento" => "fla"
      "cita" => "Nefrologia. 2012;32:427-31"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 7217
        "formatos" => array:3 [
          "EPUB" => 317
          "HTML" => 6265
          "PDF" => 635
        ]
      ]
      "es" => array:10 [
        "idiomaDefecto" => true
        "titulo" => "Importancia del donante a&#241;oso como fuente de &#243;rganos v&#225;lidos para el trasplante renal&#58; &#191;d&#243;nde est&#225; el l&#237;mite&#63;"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "427"
            "paginaFinal" => "431"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Importance of elderly donors as a source of valid organs for renal transplantation&#58; where is the limit&#63;"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => 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" => "11571_108_32287_es_11571_t1.jpg"
                "Alto" => 724
                "Ancho" => 600
                "Tamanyo" => 235876
              ]
            ]
            "descripcion" => array:1 [
              "es" => "Inmunosupresi&#243;n y evoluci&#243;n de los injertos de donantes a&#241;osos"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Ana Fern&#225;ndez-Rodr&#237;guez, Roberto Marc&#233;n-Letosa, Cristina Galeano-&#193;lvarez"
            "autores" => array:3 [
              0 => array:2 [
                "nombre" => "Ana"
                "apellidos" => "Fern&#225;ndez-Rodr&#237;guez"
              ]
              1 => array:2 [
                "nombre" => "Roberto"
                "apellidos" => "Marc&#233;n-Letosa"
              ]
              2 => array:2 [
                "nombre" => "Cristina"
                "apellidos" => "Galeano-&#193;lvarez"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "X2013251412001669"
          "doi" => "10.3265/Nefrologia.pre2012.Jun.11571"
          "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/X2013251412001669?idApp=UINPBA000064"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699512001661?idApp=UINPBA000064"
      "url" => "/02116995/0000003200000004/v0_201502091347/X0211699512001661/v0_201502091347/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:17 [
    "pii" => "X2013251412001650"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.pre2012.Apr.11472"
    "estado" => "S300"
    "fechaPublicacion" => "2012-07-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia &#40;English Version&#41;. 2012;32:432-8"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 7471
      "formatos" => array:3 [
        "EPUB" => 308
        "HTML" => 6368
        "PDF" => 795
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "titulo" => "Ischemic nephropathy &#39; pathogenesis and treatment"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "432"
          "paginaFinal" => "438"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Nefropat&#237;a isqu&#233;mica&#58; patog&#233;nesis y tratamiento"
        ]
      ]
      "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" => "11472_108_29486_en_11472_t1.jpg"
              "Alto" => 308
              "Ancho" => 600
              "Tamanyo" => 172793
            ]
          ]
          "descripcion" => array:1 [
            "en" => "Predictors of salvageability of ischemic nephropathy after revascularisation"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Marcin Adamczak, Andrzej Wiecek"
          "autores" => array:2 [
            0 => array:2 [
              "nombre" => "Marcin"
              "apellidos" => "Adamczak"
            ]
            1 => array:2 [
              "nombre" => "Andrzej"
              "apellidos" => "Wiecek"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X0211699512001653"
        "doi" => "10.3265/Nefrologia.pre2012.Apr.11472"
        "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/X0211699512001653?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251412001650?idApp=UINPBA000064"
    "url" => "/20132514/0000003200000004/v0_201502091610/X2013251412001650/v0_201502091610/en/main.assets"
  ]
  "itemAnterior" => array:17 [
    "pii" => "X2013251412001677"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.pre2012.Jun.11576"
    "estado" => "S300"
    "fechaPublicacion" => "2012-07-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia &#40;English Version&#41;. 2012;32:419-26"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 11674
      "formatos" => array:3 [
        "EPUB" => 332
        "HTML" => 10517
        "PDF" => 825
      ]
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "titulo" => "About the discrepancies between consensus documents&#44; clinical practice guidelines&#44; and legal regulations in the treatment of type 2 diabetes"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "419"
          "paginaFinal" => "426"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "A prop&#243;sito de las discrepancias entre documentos de consenso&#44; gu&#237;as de pr&#225;ctica cl&#237;nica y normativa legal en el tratamiento de la diabetes tipo 2"
        ]
      ]
      "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" => "11576_16025_33456_en_t111576i.jpg"
              "Alto" => 884
              "Ancho" => 2186
              "Tamanyo" => 182581
            ]
          ]
          "descripcion" => array:1 [
            "en" => "Oral anti-diabetic drugs and their use in chronic kidney disease according to drug technical data sheets"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => " &#42; GEENDIAB &#40;Grupo espa&#241;ol para el estudio de la nefropat&#237;a diab&#233;tica&#41; y REDINREN &#40;Red de Investigacion Renal&#41;&#46;, Alberto Mart&#237;nez-Castelao&#42;, Jos&#233; L&#46; G&#243;rriz&#42;, Eva Sola, Carlos Morillas, Ana Jover, Francisco Coronel, Juan Navarro-Gonz&#225;lez&#42;, Fernando De &#193;lvaro&#42;"
          "autores" => array:9 [
            0 => array:1 [
              "apellidos" => "&#42; GEENDIAB &#40;Grupo espa&#241;ol para el estudio de la nefropat&#237;a diab&#233;tica&#41; y REDINREN &#40;Red de Investigacion Renal&#41;&#46;"
            ]
            1 => array:2 [
              "nombre" => "Alberto"
              "apellidos" => "Mart&#237;nez-Castelao&#42;"
            ]
            2 => array:2 [
              "nombre" => "Jos&#233; L&#46;"
              "apellidos" => "G&#243;rriz&#42;"
            ]
            3 => array:2 [
              "nombre" => "Eva"
              "apellidos" => "Sola"
            ]
            4 => array:2 [
              "nombre" => "Carlos"
              "apellidos" => "Morillas"
            ]
            5 => array:2 [
              "nombre" => "Ana"
              "apellidos" => "Jover"
            ]
            6 => array:2 [
              "nombre" => "Francisco"
              "apellidos" => "Coronel"
            ]
            7 => array:2 [
              "nombre" => "Juan"
              "apellidos" => "Navarro-Gonz&#225;lez&#42;"
            ]
            8 => array:2 [
              "nombre" => "Fernando"
              "apellidos" => "De &#193;lvaro&#42;"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X021169951200167X"
        "doi" => "10.3265/Nefrologia.pre2012.Jun.11576"
        "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/X021169951200167X?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251412001677?idApp=UINPBA000064"
    "url" => "/20132514/0000003200000004/v0_201502091610/X2013251412001677/v0_201502091610/en/main.assets"
  ]
  "en" => array:12 [
    "idiomaDefecto" => true
    "titulo" => "Importance of elderly donors as a source of valid organs for renal transplantation&#58; where is the limit&#63;"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "427"
        "paginaFinal" => "431"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "Ana Fern&#225;ndez-Rodr&#237;guez, Roberto Marc&#233;n-Letosa, Cristina Galeano-&#193;lvarez"
        "autores" => array:3 [
          0 => array:4 [
            "nombre" => "Ana"
            "apellidos" => "Fern&#225;ndez-Rodr&#237;guez"
            "email" => array:1 [
              0 => "afernandezr&#46;hrc&#64;salud&#46;madrid&#46;org"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Roberto"
            "apellidos" => "Marc&#233;n-Letosa"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Cristina"
            "apellidos" => "Galeano-&#193;lvarez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:3 [
            "entidad" => "Servicio de Nefrología, Hospital Universitario Ramón y Cajal, Madrid,   "
            "etiqueta" => "<span class="elsevierStyleSup">a</span>"
            "identificador" => "affa"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Importancia del donante a&#241;oso como fuente de &#243;rganos v&#225;lidos para el trasplante renal&#58; &#191;d&#243;nde est&#225; el l&#237;mite&#63;"
      ]
    ]
    "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" => "11571_16025_33233_en_11571_t1.jpg"
            "Alto" => 2590
            "Ancho" => 2181
            "Tamanyo" => 264397
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Immunosuppression and evolution of organs from elderly donors"
        ]
      ]
    ]
    "textoCompleto" => "<p class="elsevierStylePara">In the current issue of Nefrolog&#237;a<span class="elsevierStyleItalic">&#44; </span>Dr Gonzalez Roncero et al&#44;<span class="elsevierStyleSup">1</span> all of whom are members of a study group of thirteen transplant hospitals&#44; present their results regarding the long-term evolution of 133 kidney grafts from expanded criteria donors&#46;</p><p class="elsevierStylePara">In this study&#44; immunosuppression was used with two doses of daclizumab&#44; mycophenolate mofetil&#44; normal steroid doses&#44; and late introduction of tacrolimus&#46; They present the 5-year evolution of patients that reached one year of graft survival in a study that initially used a prospective design&#44; whose results were published in 2008 in this same journal&#46; The continuation of follow-up with these patients is of great interest&#44; since it is a multi-centre study with an originally prospective study design and shows 5-year results&#44; information that is not commonly presented in the medical literature for these types of donors&#46;</p><p class="elsevierStylePara">In addition&#44; this article is of special application in Spain&#44; where the age and comorbidity of donors has increased substantially in the past two decades&#44; donor age increasing from 34 years in 1992 to 57 years in 2010&#46; Currently&#44; more than 50&#37; of donors are older than 60 years&#44; and many of them have associated comorbidity&#44; such as diabetes or arterial hypertension&#46;<span class="elsevierStyleSup">2</span></p><p class="elsevierStylePara">As a consequence of these changes in donor characteristics&#44; the scenario surrounding kidney transplants has shifted notably in recent decades&#46;</p><p class="elsevierStylePara">At the end of the 1990&#8217;s and the start of the new millennium&#44; published studies focused primarily on two different aspects&#58; the indications for transplants in elderly recipients&#44; and the evolution of grafts in elderly recipients regardless of the age of the donor&#46;</p><p class="elsevierStylePara">The indications for kidney transplants in elderly renal failure patients on dialysis was established in a study &#40;among others&#41; by Wolfe et al&#44;<span class="elsevierStyleSup">3</span> which compared the mortality of recipients of standard organs&#44; those receiving marginal organs&#44; and those who remained on the kidney waiting list&#46; In their statistical analysis&#44; the authors concluded that the mean expected survival rate was 5 years higher in transplant recipients as compared to those who remained on the wait list&#46;<span class="elsevierStyleSup">3-5</span></p><p class="elsevierStylePara">In the analysis of the evolution of kidney transplants in elderly recipients&#44; regardless of the type of donor&#44; the article published by Waiser et al is especially interesting&#46; They evaluated the 8-year survival of 1269 patients&#44; 176 of which received kidneys from donors older than 55 years &#40;132 were placed in elderly recipients and 44 in young recipients&#41;&#46; The relative risk of graft loss after 8 years was 1&#46;97 times higher in young recipients than in recipients &#62;55 years&#46;<span class="elsevierStyleSup">6</span> The cause of graft loss in young patients was primarily acute rejection &#40;33&#46;7&#37;&#41; and chronic rejection &#40;24&#37;&#41;&#46;</p><p class="elsevierStylePara">Once the safety and efficacy of transplants in elderly recipients was established&#44; and it was shown that the primary cause of graft loss in these patients was death with a functioning transplant&#44; the majority of transplant teams expanded their criteria for organ donors under the &#8220;old for old&#8221; policy&#44; in which elderly recipients received organs from expanded criteria donors&#46; This policy is reasonable&#44; since organ survival is not so important in elderly recipients as in young recipients&#46;<span class="elsevierStyleSup">7-12</span></p><p class="elsevierStylePara">Graft survival rates are worse in expanded criteria kidneys due to structural changes in kidneys that come with age&#46; These alterations include glomerulosclerosis&#44; interstitial fibrosis&#44; tubular atrophy&#44; and vascular damage&#44; which make them more sensitive to ischaemia and reperfusion damage&#46; In addition&#44; they have a higher rate of acute tubular necrosis &#40;ATN&#41; than those of young donors&#44; and higher sensitivity to calcineurin inhibitor-related nephrotoxicity&#46; Furthermore&#44; these kidneys have worse renal function one month following transplantation&#44; donor age being the main risk factor for decreased glomerular filtration rate&#46;<span class="elsevierStyleSup">10-12</span></p><p class="elsevierStylePara">Experimental studies performed in rats have suggested that acute failure is more probable in older kidney transplants&#59; however&#44; these experimental data have produced contradictory results in human studies&#46;<span class="elsevierStyleSup">13-15</span></p><p class="elsevierStylePara">Other characteristics of elderly recipients include metabolic changes that can induce differences in the pharmacokinetics of immunosuppressants and other drugs&#44; more cardiovascular risk factors and immune system alterations&#44; making patients more susceptible to infections and tumours&#46;<span class="elsevierStyleSup">16&#44;17</span> In fact&#44; in the study by Gonzalez-Roncero et al<span class="elsevierStyleSup">1</span> previously mentioned&#44; 7 of the 10 deaths were due to tumours&#46;</p><p class="elsevierStylePara">All of these physiological changes in elderly donors and recipients have generated substantial interest in achieving optimal immunosuppression when organs are derived from elderly donors in all transplant recipient groups&#46;</p><p class="elsevierStylePara">In the majority of these studies&#44; induction therapy is used with early introduction of calcineurin inhibitors at lower doses than in standard donors&#44; or&#44; as in the case we are focusing on&#44; with calcineurin inhibitors starting a few days after transplantation&#46;<span class="elsevierStyleSup">1&#44;15&#44;18-26</span></p><p class="elsevierStylePara">Other groups have opted to avoid calcineurin inhibitors altogether&#44; using instead high induction doses with proliferation signal inhibitors or mycophenolate mofetil directly following transplantation&#46;<span class="elsevierStyleSup">27&#44;28</span></p><p class="elsevierStylePara">Unfortunately&#44; we lack prospective randomised studies that might definitively establish an optimal immunosuppression regimen in this group of donors&#47;recipients&#44; who require such a delicate equilibrium between immunosuppression and immunocompetence&#46; This is due to the fact that the majority of clinical trials have excluded elderly recipients in order to avoid the side effects associated with the characteristics of these recipients&#46;</p><p class="elsevierStylePara">Treatment protocols that do not include calcineurin inhibitors&#44; such as that described by Abrogast and Guba&#44;<span class="elsevierStyleSup">27&#44;28</span> may cause an excessive rate of acute rejection&#44; higher than 50&#37;&#46; This study&#8217;s protocol was based on high initial induction doses of thymoglobulin at 4mg&#47;kg&#47;day on day zero and two doses of basiliximab followed by high steroid and mycophenolate doses&#44; which did not reduce the rate of ATN or provide benefits in terms of mid-term patient or graft survival&#46;<span class="elsevierStyleSup">28</span></p><p class="elsevierStylePara">In protocols involving late introduction of calcineurin inhibitors &#40;which range between 3 and 7 days&#41;&#44; the rate of acute rejection is acceptable&#44; and graft and patient survival rates are adequate&#46;<span class="elsevierStyleSup">19&#44;20&#44;22&#44;25</span> In the study published in this issue&#44;<span class="elsevierStyleSup">1</span> the acute rejection rate was 13&#37;&#44; and patient and graft survival rates adjusted for patient death after one year of follow-up were 97&#46;7&#37; and 96&#46;1&#37;&#44; respectively&#44; some of the highest rates published in the medical literature&#46;<span class="elsevierStyleSup">20</span></p><p class="elsevierStylePara">One particularly interesting result of this study was the low rate of acute rejection when using two doses of daclizumab&#44; a drug that was initially designed for use in five doses&#44; which without a doubt has considerably decreased the initial costs of treatment for this condition&#44; without increasing the rate of acute rejection&#46;</p><p class="elsevierStylePara">In this study&#44; the results after 5 years were also good&#44; with patient survival at 93&#46;3&#37; and graft survival at 93&#46;8&#37; &#40;adjusted for patient death&#41;&#46; This could be due to close follow-up of patients in this study&#44; with a very strict control of cardiovascular risk factors&#44; since at the end of the follow-up period&#44; 92&#37; of patients received antihypertensive drugs&#44; 63&#37; statins&#44; 18&#46;4&#37; erythropoietin&#44; and 15&#37; oral anti-diabetics or insulin&#46; This very close clinical surveillance&#44; along with low doses and low blood levels of tacrolimus over the 5-year follow-up period&#44; undoubtedly contributed to the good results obtained&#46;</p><p class="elsevierStylePara">In our hospital&#44; we use a regimen based on induction with basiliximab in two doses&#44; early introduction of calcineurin inhibitors &#40;day &#43;1 post-transplant&#41; at one-half the normal dose&#44; and low target levels&#46; We analysed graft and patient survival in especially elderly donors &#40;older than 70 years&#41;&#46; These data were published by Galeano et al<span class="elsevierStyleSup">26</span> and showed an acute rejection rate &#40;8&#46;5&#37;&#41; and ATN of 38&#46;5&#37;&#46; Compared with donors aged 50-70 years&#44; very elderly donors do not show a higher rate of acute rejection or ATN&#46; Graft survival rates without adjusting for death are similar between recipients from donors aged 50-70 years and recipients from donors older than 70 years&#44; with evidently higher mortality rates in the group of older recipients&#46;<span class="elsevierStyleSup">26</span></p><p class="elsevierStylePara">The Table summarises the initial immunosuppression treatment&#44; donor and recipient age&#44; incidence of ATN&#44; incidence of acute rejection&#44; and patient and graft survival after 1 and 5 years in elderly recipients in selected articles&#46; It is evident in articles published in recent years that donor and recipient age is very advanced&#44; and is notably higher than in the article published in this issue&#46;<span class="elsevierStyleSup">1</span></p><p class="elsevierStylePara">In the studies by Foss&#44; Collini&#44; Favi&#44; and Galeano&#44;<span class="elsevierStyleSup">23-26</span> taking into account the advanced age of both donors and recipients&#44; patient and graft survival rates were adequate and&#44; in comparison to articles published at the start of the new millennium&#44; the mean age of donors and recipients has increased without having established an age limit for donors or recipients&#46;</p><p class="elsevierStylePara">The results from the three-year BENEFIT EXT study<span class="elsevierStyleSup">31 </span>were published recently&#44; in which belatacept administered with cyclosporine and mycophenolate mofetil resulted especially beneficial for improving glomerular filtration rates in recipients of organs from elderly donors&#46; There were no significant differences in the rate of acute rejection as compared to the control group&#44; which received cyclosporine&#44; mycophenolate&#44; and steroids&#46;</p><p class="elsevierStylePara">Without a doubt&#44; organ transplants from elderly donors require special treatment in the immediate postoperative period&#44; including minimal cold ischaemia time&#44; immunosuppression adjusted for donor&#47;recipient characteristics&#44; the highest possible number of HLA compatibilities&#44; and minimal use of calcineurin inhibitors&#46; This study shows the vital importance of continuing optimal treatment over time&#44; minimising the use of calcineurin inhibitors&#44; and proper control of cardiovascular risk factors&#46; The long-term benefits of belatacept in these patients remain to be established&#46;</p><p class="elsevierStylePara"><a href="grande&#47;11571&#95;16025&#95;33233&#95;en&#95;11571&#95;t1&#46;jpg" class="elsevierStyleCrossRefs"><img src="11571_16025_33233_en_11571_t1.jpg" alt="Immunosuppression and evolution of organs from elderly donors"></img></a></p><p class="elsevierStylePara">Table 1&#46; Immunosuppression and evolution of organs from elderly donors</p>"
    "pdfFichero" => "P1-E541-S3620-A11571-EN.pdf"
    "tienePdf" => true
    "multimedia" => array:1 [
      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" => "11571_16025_33233_en_11571_t1.jpg"
            "Alto" => 2590
            "Ancho" => 2181
            "Tamanyo" => 264397
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Immunosuppression and evolution of organs from elderly donors"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliography"
      "seccion" => array:1 [
        0 => array:1 [
          "bibliografiaReferencia" => array:31 [
            0 => array:3 [
              "identificador" => "bib1"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "González-Roncero FM, Gentil-Govantes MA, González-Molina M, Rivero M, Cantarell C, Alarcón A, et al. Evolución tardía del trasplante renal de donante y receptor añosos con una inmunosupresión inicial con daclizumab, mofetil-micofenolato e introducción retrasada de tacrolimus. Nefrologia 2012;32(4):xx-xx."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib2"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Organización Nacional de Trasplantes. Memorias - Datos de donación y trasplante renal de la ONT [varios años]. Available at:\u{A0}http://www.ont.es/infesp/Paginas/Memorias.aspx"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib3"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Wolfe RA,\u{A0}Ashby VB,\u{A0}Milford EL,\u{A0}Ojo AO,\u{A0}Ettenger RE,\u{A0}Agodoa LY, et al. Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation and recipients of a first cadaveric transplant. N Engl J Med 1999;341:1725-30. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10580071" 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" => "Ojo AO, Hanson JA, Meier-Kriesche H, Okechukwu CN, Wolfe RA, Leichtman AB, et al. Survival in recipients of marginal cadaveric donor kidney compared with other recipients and wait-listed transplant canditates. J Am Soc Nephrol 2001;12:589-97. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11181808" 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" => "McDonald S, Russ G. Survival of recipients of cadaveric kidney transplant with those receiving dialysis treatment in Austria and New Zeland, 1991-2001. Nephrol Dial Transplant 2002,17:2212-9."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib6"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Waiser J, Schreiber M, Budde K, Fritsche L,\u{A0}Böhler T,\u{A0}Hauser I,\u{A0}et al. Age-matching in renal tansplantation. Nephrol Dial Transplant 2000;15:696-700. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10809813" 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" => "Cohen B, Smits JM, Hase B, Persijn G,\u{A0}Vanrenterghem Y,\u{A0}Frei U. Expanding the donor pool to increase renal transplantation. Nephrol Dial Transplant 2005;20:34-41. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15522904" 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" => "Beckurts UTA, Stippel D, Pollok M, Arns W,\u{A0}Weber M,\u{A0}Hölscher AH. Single center experience with the old for old program for renal transplantation. Transplant Proc 2001;33:3779-80. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11750608" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib9"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Fritsche L, Hörstrup J, Budde K, Reinke P,\u{A0}Giessing M,\u{A0}Tullius S,\u{A0}et al. Old for old kidney allocation allows successful expansion of the donor and recipients pool. Am J Transplant 2003;3:1434-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/14525606" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Zhou XJ, Rakheja D, Yu X, Saxena R,\u{A0}Vaziri ND,\u{A0}Silva FG. Te ageing kidney. Kidney Int 2008;74:710-20. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18614996" 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" => "Feinfeld DA, Guzik H, Cavournis C, Lynn RI,\u{A0}Somer B,\u{A0}Aronson MK,\u{A0}et al. Sequential changes in renal fuction tests on the old: results from de Bronx Longitudinal Aging Study. J Am Geriatr Soc 1995;43:412-4. <a href="http://www.ncbi.nlm.nih.gov/pubmed/7706633" 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" => "Siddidi N, McBride MA, Hariaharan S. Similar risk profiles for postransplant dysfunction and long term graft faillure: UNOS/OPTN database analysis. Kidney Int 2004;65:1906-13. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15086934" 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" => "Reutzel-Selke A, Filatenov A, Jurische A, Denecke C,\u{A0}Martins PN,\u{A0}Pascher A,\u{A0}et al. Grafts from elderly donors elict a stronger immune response in the early period postransplantation. A study in a rat model. Transplant Proc 2005;37(1):382-3. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15808652" 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" => "Lim WH, Ghang S, Chadban S, Campbell S, Dent H, Russ GR,\u{A0}et al. Donor-recipient age matching improves years of graft function in deceased donor kidney transplantation. Nephrol Dial Transplant 2010;25(9):3082-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20736266" 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" => "Bodingbauer M, Pakrah B, Steininger R, Berlakovich G,\u{A0}Rockenschaub S,\u{A0}Wekerle T,\u{A0}et al. The advantage of allocating kidney from old cadaveric donors to old recipients. A single center experience. Clin Transplant 2006;20:471-5. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16842524" 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" => "Meier-Kriesche HU,\u{A0}Ojo A,\u{A0}Hanson J,\u{A0}Cibrik D,\u{A0}Lake K,\u{A0}Agodoa LY, et al. Increased immunosuppressive vulnerability in the elderly renal transplant recipients. Transplantation 2000;69:885-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10755545" 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" => "Trouillet I, Benito N, Cervera C, Rivas P,\u{A0}Cofán F,\u{A0}Almela M,\u{A0}et al. Infuence of age in renal transplant infections. Cases and control study. Transplantation 2005;80:989-92. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16249750" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib18"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Daniovicht GM, Gill J, Bunnapradist S. Immunosupression of the elderly kidney transplant recipient. Transplantation 2007;84(3):285-91. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17700150" 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" => "Emparan C, Wolters H, Laukotter M, Senninger N. Long term results of calcineurion free protocols with basiliximab induction in old to old programs. Transplant Proc 2004;36:2646-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15621113" 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" => "Gentil MA, Osuna A, Capdevilla L, Cantarell C,\u{A0}Pereira P,\u{A0}Mazuecos A,\u{A0}et al. Daclizumab en combinación con micofenolato mofetilo e introducción tardía de tacrolimus a dosis bajas, como opción terapéutica en la pareja donante-receptor añoso en trasplante renal. Nefrologia 2008;28(3):287-92. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18590495" 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" => "Smits JM, Persijn GG, Van Houwelingen HC, Claas FH,\u{A0}Frei U. Evaluation of the Eurotransplant Senior Program. The results of the first year. Am J Transplant 2002;2:664-70. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12201369" 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" => "Stratta RJ, Sudberg AK, Rohr R, Farney AC,\u{A0}Hartmann EL,\u{A0}Roskopf JA,\u{A0}el al. Optimal use the old donors and recipients in kidney transplantation. Surgery 2006;139:324-33. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16546496" 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" => "Foss A, Heldal K, Scott H, Foss S,\u{A0}Leivestad T,\u{A0}Jørgensen PF,\u{A0}et al. Kidneys from deceased donors more than 75 years perform acceptably after transplantation. Transplantation 2009;87:1437-41. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19461478" 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" => "Collini A, Kalmar P, Damo A, Ruggieri G,\u{A0}Carmellini M. Renal transplantation from very old donors. How far can we go? Transplantation 2009;87:1437-41."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib25"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Favi E, Gargiulo A, Spagnoletti G, Salerno MP,\u{A0}Silvestrini N,\u{A0}Valente I,\u{A0}et al. Induction with basiliximab plus thymoglobulin is effective and safe in old for old renal transplantation: Six months results of a prospective clinical study. Transplant Proc\u{A0}2010;42(4):1114-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20534237" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib26"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Galeano C, Marcén R, Jimenez S, Fernández Rodríguez A,\u{A0}Sosa H,\u{A0}Villafruela JJ,\u{A0}et al. Utilization of elderly kidney donors (>70 years) does not affect graf survival in medium term. Transplant Proc 2010;42:3935-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21168591" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib27"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Arbogast H, Huckelheim H, Shneeberger H, Illner WD,\u{A0}Tarabichi A,\u{A0}Fertmann J,\u{A0}et al. A calcineurin antagonist free induction/maintenance strategy for inmunossupresión in elderly recipients of renal allograft from elderly cadaver donors. Clin Transplant 2005;19:309-15. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15877790" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib28"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Guba M, Rentsch M, Wimmer CD, Uemueksuez A, Illner WD, Schönermarck U,\u{A0}et al. Calcineurin inhibitor avoidance in elderly renal allograft recipients using ATG y basiliximab combined with mycofenolate mofetil. Transpl Int 2008;21:637-45. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18282242" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib29"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Frei U, Noeldeke J, Machold-Fabrizzi V, Arbogast H,\u{A0}Margreiter R,\u{A0}Fricke L,\u{A0}et al. Prospective age maching in elderly kidney transplant recipients. A 5 years analysis of the Eurotransplant Senior Program. Am J Transplant 2008;8:50-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17973969" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib30"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Palomar R, Ruiz JC, Zubimendi JA, Cotorruelo JG,\u{A0}de Francisco AL,\u{A0}Rodrigo E, et al. Acute rejection in the early recipient: Influence of age in the outcome of kideny transplantation. Int Urol Nephrol 2002;33:145-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12090322" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib31"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Pestana JO, Griñó JM, Varenterghem Y, Becker T,\u{A0}Campistol JM,\u{A0}Florman S,\u{A0}et al. Three-year outcomes from Benefit-ext: a phase III study of belatacept versus cyclosporine in recipients of extended criteria donor kidneys. Am J Transplant 2012;12(3):630-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/22300431" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/20132514/0000003200000004/v0_201502091610/X2013251412001669/v0_201502091610/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "35428"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Editorial Comments"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003200000004/v0_201502091610/X2013251412001669/v0_201502091610/en/P1-E541-S3620-A11571-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251412001669?idApp=UINPBA000064"
]
Article information
ISSN: 20132514
Original language: English
The statistics are updated each day
Year/Month Html Pdf Total
2024 November 9 5 14
2024 October 53 49 102
2024 September 48 30 78
2024 August 72 63 135
2024 July 50 29 79
2024 June 69 36 105
2024 May 61 40 101
2024 April 68 33 101
2024 March 47 29 76
2024 February 30 37 67
2024 January 40 19 59
2023 December 34 21 55
2023 November 41 34 75
2023 October 42 31 73
2023 September 29 32 61
2023 August 39 16 55
2023 July 42 30 72
2023 June 31 23 54
2023 May 44 28 72
2023 April 30 14 44
2023 March 37 16 53
2023 February 27 21 48
2023 January 30 32 62
2022 December 45 29 74
2022 November 53 35 88
2022 October 54 51 105
2022 September 39 35 74
2022 August 49 54 103
2022 July 36 44 80
2022 June 45 36 81
2022 May 49 28 77
2022 April 22 39 61
2022 March 47 53 100
2022 February 39 46 85
2022 January 49 30 79
2021 December 74 45 119
2021 November 46 37 83
2021 October 44 54 98
2021 September 33 37 70
2021 August 29 42 71
2021 July 47 29 76
2021 June 56 35 91
2021 May 27 40 67
2021 April 91 74 165
2021 March 59 58 117
2021 February 42 23 65
2021 January 37 24 61
2020 December 25 17 42
2020 November 36 15 51
2020 October 17 18 35
2020 September 37 7 44
2020 August 43 11 54
2020 July 24 9 33
2020 June 35 15 50
2020 May 31 7 38
2020 April 25 10 35
2020 March 30 18 48
2020 February 30 16 46
2020 January 34 18 52
2019 December 33 16 49
2019 November 33 25 58
2019 October 18 12 30
2019 September 28 28 56
2019 August 21 10 31
2019 July 25 26 51
2019 June 22 15 37
2019 May 49 20 69
2019 April 66 27 93
2019 March 29 24 53
2019 February 28 19 47
2019 January 38 21 59
2018 December 77 41 118
2018 November 95 19 114
2018 October 65 20 85
2018 September 68 19 87
2018 August 53 17 70
2018 July 44 21 65
2018 June 44 15 59
2018 May 50 20 70
2018 April 79 12 91
2018 March 60 5 65
2018 February 63 7 70
2018 January 63 6 69
2017 December 62 9 71
2017 November 56 17 73
2017 October 36 13 49
2017 September 41 12 53
2017 August 38 24 62
2017 July 38 20 58
2017 June 56 23 79
2017 May 45 14 59
2017 April 90 18 108
2017 March 68 16 84
2017 February 34 20 54
2017 January 20 24 44
2016 December 66 8 74
2016 November 89 17 106
2016 October 123 11 134
2016 September 164 7 171
2016 August 246 15 261
2016 July 221 11 232
2016 June 150 0 150
2016 May 162 0 162
2016 April 112 0 112
2016 March 118 0 118
2016 February 135 0 135
2016 January 253 0 253
2015 December 136 0 136
2015 November 118 0 118
2015 October 101 0 101
2015 September 86 0 86
2015 August 90 0 90
2015 July 85 0 85
2015 June 49 0 49
2015 May 69 0 69
2015 April 7 0 7
Show all

Follow this link to access the full text of the article

Idiomas
Nefrología (English Edition)
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?