Effect of mammalian target of rapamycin inhibitors on cytomegalovirus infection in kidney transplant recipients receiving polyclonal antilymphocyte globulins: a propensity score-matching analysis.
Identifieur interne : 000945 ( Main/Corpus ); précédent : 000944; suivant : 000946Effect of mammalian target of rapamycin inhibitors on cytomegalovirus infection in kidney transplant recipients receiving polyclonal antilymphocyte globulins: a propensity score-matching analysis.
Auteurs : Carlos Cervera ; Frederic Cofan ; Cristina Hernandez ; Dolors Soy ; Maria Angeles Marcos ; Gemma Sanclemente ; Marta Bodro ; Asunci N Moreno ; Fritz Diekmann ; Josep Maria Campistol ; Frederic OppenheimerSource :
- Transplant international : official journal of the European Society for Organ Transplantation [ 1432-2277 ] ; 2016.
English descriptors
- KwdEn :
- Adult (MeSH), Aged (MeSH), Antilymphocyte Serum (therapeutic use), Calcineurin Inhibitors (therapeutic use), Cytomegalovirus Infections (drug therapy), Cytomegalovirus Infections (prevention & control), Female (MeSH), Humans (MeSH), Immunosuppression (MeSH), Immunosuppressive Agents (therapeutic use), Kidney Transplantation (MeSH), Male (MeSH), Middle Aged (MeSH), Multivariate Analysis (MeSH), Propensity Score (MeSH), Proportional Hazards Models (MeSH), Renal Insufficiency (surgery), Retrospective Studies (MeSH), Risk (MeSH), Sirolimus (therapeutic use), Spain (MeSH), TOR Serine-Threonine Kinases (antagonists & inhibitors).
- MESH :
- chemical , antagonists & inhibitors : TOR Serine-Threonine Kinases.
- chemical , therapeutic use : Antilymphocyte Serum, Calcineurin Inhibitors, Immunosuppressive Agents, Sirolimus.
- drug therapy : Cytomegalovirus Infections.
- prevention & control : Cytomegalovirus Infections.
- surgery : Renal Insufficiency.
- Adult, Aged, Female, Humans, Immunosuppression, Kidney Transplantation, Male, Middle Aged, Multivariate Analysis, Propensity Score, Proportional Hazards Models, Retrospective Studies, Risk, Spain.
Abstract
Mammalian target of rapamycin inhibitors (mTORi) prevents cytomegalovirus (CMV) infection in kidney transplant (KT) patients. From May 2010 to December 2013, all KT recipients were retrospectively analysed. Maintenance immunosuppression regimen was divided into mTORi or calcineurin inhibitors (CNI)-based regimen. Since June 2011, CMV-seropositive recipients (R+) treated with high-intensity immunosuppression and mTORi did not receive anti-CMV prophylaxis. We analysed 350 consecutive patients, of which 95 (27%) received mTORi and 255 (73%) CNI-based immunosuppression. A Cox-regression multivariate analysis showed that the use of mTORi-based immunosuppression during all follow-up reduced the risk of CMV infection (HR 0.36, 95% CI 0.15-0.89, P = 0.028) and confirmed in a propensity score-matched cohort (HR 0.4, 95% CI 0.1-0.9, P = 0.047). Early discontinuation of mTORi increased the risk of CMV infection (HR 3.2; 95% CI 1.7-6.0) in univariate analysis. The incidence of CMV infection was not higher among CMV R+ patients on mTORi and requiring high-intensity immunosuppression when CMV prophylaxis was not given. The use of mTORi protected for CMV infection in KT patients, allowing to avoid antiviral prophylaxis for R+ patients receiving high-intensity immunosuppression. The increased risk of CMV infection after early discontinuation of mTORi warrants further research.
DOI: 10.1111/tri.12848
PubMed: 27564469
Links to Exploration step
pubmed:27564469Le document en format XML
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Nephrology, IDIBAPS, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.</nlm:affiliation></affiliation></author><author><name sortKey="Hernandez, Cristina" sort="Hernandez, Cristina" uniqKey="Hernandez C" first="Cristina" last="Hernandez">Cristina Hernandez</name><affiliation><nlm:affiliation>Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, AB, Canada.</nlm:affiliation></affiliation></author><author><name sortKey="Soy, Dolors" sort="Soy, Dolors" uniqKey="Soy D" first="Dolors" last="Soy">Dolors Soy</name><affiliation><nlm:affiliation>Division of Pharmacy, IDIBAPS, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.</nlm:affiliation></affiliation></author><author><name sortKey="Marcos, Maria Angeles" sort="Marcos, Maria Angeles" uniqKey="Marcos M" first="Maria Angeles" last="Marcos">Maria Angeles Marcos</name><affiliation><nlm:affiliation>Division of Microbiology, Centre Diagnòstic Biomèdic (CDB), Centre 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Transplantation Unit, Division of Nephrology, IDIBAPS, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.</nlm:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2016">2016</date><idno type="RBID">pubmed:27564469</idno><idno type="pmid">27564469</idno><idno type="doi">10.1111/tri.12848</idno><idno type="wicri:Area/Main/Corpus">000945</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Corpus" wicri:corpus="PubMed">000945</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Effect of mammalian target of rapamycin inhibitors on cytomegalovirus infection in kidney transplant recipients receiving polyclonal antilymphocyte globulins: a propensity score-matching analysis.</title><author><name sortKey="Cervera, Carlos" sort="Cervera, Carlos" uniqKey="Cervera C" first="Carlos" last="Cervera">Carlos Cervera</name><affiliation><nlm:affiliation>Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, AB, Canada. cerveraa@ualberta.ca.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Division of Infectious Diseases, IDIBAPS, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain. cerveraa@ualberta.ca.</nlm:affiliation></affiliation></author><author><name sortKey="Cofan, Frederic" sort="Cofan, Frederic" uniqKey="Cofan F" first="Frederic" last="Cofan">Frederic Cofan</name><affiliation><nlm:affiliation>Renal Transplantation Unit, Division of Nephrology, IDIBAPS, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.</nlm:affiliation></affiliation></author><author><name sortKey="Hernandez, Cristina" sort="Hernandez, Cristina" uniqKey="Hernandez C" first="Cristina" last="Hernandez">Cristina Hernandez</name><affiliation><nlm:affiliation>Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, AB, Canada.</nlm:affiliation></affiliation></author><author><name sortKey="Soy, Dolors" sort="Soy, Dolors" uniqKey="Soy D" first="Dolors" last="Soy">Dolors Soy</name><affiliation><nlm:affiliation>Division of Pharmacy, IDIBAPS, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.</nlm:affiliation></affiliation></author><author><name sortKey="Marcos, Maria Angeles" sort="Marcos, Maria Angeles" uniqKey="Marcos M" first="Maria Angeles" last="Marcos">Maria Angeles Marcos</name><affiliation><nlm:affiliation>Division of Microbiology, Centre Diagnòstic Biomèdic (CDB), Centre for International Health Research (CRESIB), IDIBAPS, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.</nlm:affiliation></affiliation></author><author><name sortKey="Sanclemente, Gemma" sort="Sanclemente, Gemma" uniqKey="Sanclemente G" first="Gemma" last="Sanclemente">Gemma Sanclemente</name><affiliation><nlm:affiliation>Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, AB, Canada.</nlm:affiliation></affiliation></author><author><name sortKey="Bodro, Marta" sort="Bodro, Marta" uniqKey="Bodro M" first="Marta" last="Bodro">Marta Bodro</name><affiliation><nlm:affiliation>Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, AB, Canada.</nlm:affiliation></affiliation></author><author><name sortKey="Moreno, Asunci N" sort="Moreno, Asunci N" uniqKey="Moreno A" first="Asunci N" last="Moreno">Asunci N Moreno</name><affiliation><nlm:affiliation>Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, AB, Canada.</nlm:affiliation></affiliation></author><author><name sortKey="Diekmann, Fritz" sort="Diekmann, Fritz" uniqKey="Diekmann F" first="Fritz" last="Diekmann">Fritz Diekmann</name><affiliation><nlm:affiliation>Renal Transplantation Unit, Division of Nephrology, IDIBAPS, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.</nlm:affiliation></affiliation></author><author><name sortKey="Campistol, Josep Maria" sort="Campistol, Josep Maria" uniqKey="Campistol J" first="Josep Maria" last="Campistol">Josep Maria Campistol</name><affiliation><nlm:affiliation>Renal Transplantation Unit, Division of Nephrology, IDIBAPS, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.</nlm:affiliation></affiliation></author><author><name sortKey="Oppenheimer, Frederic" sort="Oppenheimer, Frederic" uniqKey="Oppenheimer F" first="Frederic" last="Oppenheimer">Frederic Oppenheimer</name><affiliation><nlm:affiliation>Renal Transplantation Unit, Division of Nephrology, IDIBAPS, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.</nlm:affiliation></affiliation></author></analytic><series><title level="j">Transplant international : official journal of the European Society for Organ Transplantation</title><idno type="eISSN">1432-2277</idno><imprint><date when="2016" type="published">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult (MeSH)</term><term>Aged (MeSH)</term><term>Antilymphocyte Serum (therapeutic use)</term><term>Calcineurin Inhibitors (therapeutic use)</term><term>Cytomegalovirus Infections (drug therapy)</term><term>Cytomegalovirus Infections (prevention & control)</term><term>Female (MeSH)</term><term>Humans (MeSH)</term><term>Immunosuppression (MeSH)</term><term>Immunosuppressive Agents (therapeutic use)</term><term>Kidney Transplantation (MeSH)</term><term>Male (MeSH)</term><term>Middle Aged (MeSH)</term><term>Multivariate Analysis (MeSH)</term><term>Propensity Score (MeSH)</term><term>Proportional Hazards Models (MeSH)</term><term>Renal Insufficiency (surgery)</term><term>Retrospective Studies (MeSH)</term><term>Risk (MeSH)</term><term>Sirolimus (therapeutic use)</term><term>Spain (MeSH)</term><term>TOR Serine-Threonine Kinases (antagonists & inhibitors)</term></keywords><keywords scheme="MESH" type="chemical" qualifier="antagonists & inhibitors" xml:lang="en"><term>TOR Serine-Threonine Kinases</term></keywords><keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Antilymphocyte Serum</term><term>Calcineurin Inhibitors</term><term>Immunosuppressive Agents</term><term>Sirolimus</term></keywords><keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>Cytomegalovirus Infections</term></keywords><keywords scheme="MESH" qualifier="prevention & control" xml:lang="en"><term>Cytomegalovirus Infections</term></keywords><keywords scheme="MESH" qualifier="surgery" xml:lang="en"><term>Renal Insufficiency</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adult</term><term>Aged</term><term>Female</term><term>Humans</term><term>Immunosuppression</term><term>Kidney Transplantation</term><term>Male</term><term>Middle Aged</term><term>Multivariate Analysis</term><term>Propensity Score</term><term>Proportional Hazards Models</term><term>Retrospective Studies</term><term>Risk</term><term>Spain</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Mammalian target of rapamycin inhibitors (mTORi) prevents cytomegalovirus (CMV) infection in kidney transplant (KT) patients. From May 2010 to December 2013, all KT recipients were retrospectively analysed. Maintenance immunosuppression regimen was divided into mTORi or calcineurin inhibitors (CNI)-based regimen. Since June 2011, CMV-seropositive recipients (R+) treated with high-intensity immunosuppression and mTORi did not receive anti-CMV prophylaxis. We analysed 350 consecutive patients, of which 95 (27%) received mTORi and 255 (73%) CNI-based immunosuppression. A Cox-regression multivariate analysis showed that the use of mTORi-based immunosuppression during all follow-up reduced the risk of CMV infection (HR 0.36, 95% CI 0.15-0.89, P = 0.028) and confirmed in a propensity score-matched cohort (HR 0.4, 95% CI 0.1-0.9, P = 0.047). Early discontinuation of mTORi increased the risk of CMV infection (HR 3.2; 95% CI 1.7-6.0) in univariate analysis. The incidence of CMV infection was not higher among CMV R+ patients on mTORi and requiring high-intensity immunosuppression when CMV prophylaxis was not given. The use of mTORi protected for CMV infection in KT patients, allowing to avoid antiviral prophylaxis for R+ patients receiving high-intensity immunosuppression. The increased risk of CMV infection after early discontinuation of mTORi warrants further research.</div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">27564469</PMID><DateCompleted><Year>2017</Year><Month>08</Month><Day>03</Day></DateCompleted><DateRevised><Year>2017</Year><Month>08</Month><Day>17</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1432-2277</ISSN><JournalIssue CitedMedium="Internet"><Volume>29</Volume><Issue>11</Issue><PubDate><Year>2016</Year><Month>Nov</Month></PubDate></JournalIssue><Title>Transplant international : official journal of the European Society for Organ Transplantation</Title><ISOAbbreviation>Transpl Int</ISOAbbreviation></Journal><ArticleTitle>Effect of mammalian target of rapamycin inhibitors on cytomegalovirus infection in kidney transplant recipients receiving polyclonal antilymphocyte globulins: a propensity score-matching analysis.</ArticleTitle><Pagination><MedlinePgn>1216-1225</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1111/tri.12848</ELocationID><Abstract><AbstractText>Mammalian target of rapamycin inhibitors (mTORi) prevents cytomegalovirus (CMV) infection in kidney transplant (KT) patients. From May 2010 to December 2013, all KT recipients were retrospectively analysed. Maintenance immunosuppression regimen was divided into mTORi or calcineurin inhibitors (CNI)-based regimen. Since June 2011, CMV-seropositive recipients (R+) treated with high-intensity immunosuppression and mTORi did not receive anti-CMV prophylaxis. We analysed 350 consecutive patients, of which 95 (27%) received mTORi and 255 (73%) CNI-based immunosuppression. A Cox-regression multivariate analysis showed that the use of mTORi-based immunosuppression during all follow-up reduced the risk of CMV infection (HR 0.36, 95% CI 0.15-0.89, P = 0.028) and confirmed in a propensity score-matched cohort (HR 0.4, 95% CI 0.1-0.9, P = 0.047). Early discontinuation of mTORi increased the risk of CMV infection (HR 3.2; 95% CI 1.7-6.0) in univariate analysis. The incidence of CMV infection was not higher among CMV R+ patients on mTORi and requiring high-intensity immunosuppression when CMV prophylaxis was not given. The use of mTORi protected for CMV infection in KT patients, allowing to avoid antiviral prophylaxis for R+ patients receiving high-intensity immunosuppression. The increased risk of CMV infection after early discontinuation of mTORi warrants further research.</AbstractText><CopyrightInformation>© 2016 Steunstichting ESOT.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Cervera</LastName><ForeName>Carlos</ForeName><Initials>C</Initials><AffiliationInfo><Affiliation>Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, AB, Canada. cerveraa@ualberta.ca.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Division of Infectious Diseases, IDIBAPS, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain. cerveraa@ualberta.ca.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Cofan</LastName><ForeName>Frederic</ForeName><Initials>F</Initials><AffiliationInfo><Affiliation>Renal Transplantation Unit, Division of Nephrology, IDIBAPS, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Hernandez</LastName><ForeName>Cristina</ForeName><Initials>C</Initials><AffiliationInfo><Affiliation>Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, AB, Canada.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Soy</LastName><ForeName>Dolors</ForeName><Initials>D</Initials><AffiliationInfo><Affiliation>Division of Pharmacy, IDIBAPS, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Marcos</LastName><ForeName>Maria Angeles</ForeName><Initials>MA</Initials><AffiliationInfo><Affiliation>Division of Microbiology, Centre Diagnòstic Biomèdic (CDB), Centre for International Health Research (CRESIB), IDIBAPS, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Sanclemente</LastName><ForeName>Gemma</ForeName><Initials>G</Initials><AffiliationInfo><Affiliation>Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, AB, Canada.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Bodro</LastName><ForeName>Marta</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, AB, Canada.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Moreno</LastName><ForeName>Asunción</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, AB, Canada.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Diekmann</LastName><ForeName>Fritz</ForeName><Initials>F</Initials><AffiliationInfo><Affiliation>Renal Transplantation Unit, Division of Nephrology, IDIBAPS, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Campistol</LastName><ForeName>Josep Maria</ForeName><Initials>JM</Initials><AffiliationInfo><Affiliation>Renal Transplantation Unit, Division of Nephrology, IDIBAPS, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Oppenheimer</LastName><ForeName>Frederic</ForeName><Initials>F</Initials><AffiliationInfo><Affiliation>Renal Transplantation Unit, Division of Nephrology, IDIBAPS, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2016</Year><Month>09</Month><Day>26</Day></ArticleDate></Article><MedlineJournalInfo><Country>England</Country><MedlineTA>Transpl Int</MedlineTA><NlmUniqueID>8908516</NlmUniqueID><ISSNLinking>0934-0874</ISSNLinking></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D000961">Antilymphocyte Serum</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D065095">Calcineurin Inhibitors</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D007166">Immunosuppressive Agents</NameOfSubstance></Chemical><Chemical><RegistryNumber>EC 2.7.1.1</RegistryNumber><NameOfSubstance UI="C546842">MTOR protein, human</NameOfSubstance></Chemical><Chemical><RegistryNumber>EC 2.7.1.1</RegistryNumber><NameOfSubstance UI="D058570">TOR Serine-Threonine Kinases</NameOfSubstance></Chemical><Chemical><RegistryNumber>W36ZG6FT64</RegistryNumber><NameOfSubstance UI="D020123">Sirolimus</NameOfSubstance></Chemical></ChemicalList><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000328" MajorTopicYN="N">Adult</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000368" MajorTopicYN="N">Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000961" MajorTopicYN="N">Antilymphocyte Serum</DescriptorName><QualifierName UI="Q000627" MajorTopicYN="Y">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D065095" MajorTopicYN="N">Calcineurin Inhibitors</DescriptorName><QualifierName UI="Q000627" MajorTopicYN="N">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D003586" MajorTopicYN="N">Cytomegalovirus Infections</DescriptorName><QualifierName UI="Q000188" MajorTopicYN="N">drug therapy</QualifierName><QualifierName UI="Q000517" MajorTopicYN="Y">prevention & control</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D007165" MajorTopicYN="N">Immunosuppression</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D007166" MajorTopicYN="N">Immunosuppressive Agents</DescriptorName><QualifierName UI="Q000627" MajorTopicYN="N">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D016030" MajorTopicYN="Y">Kidney Transplantation</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D015999" MajorTopicYN="N">Multivariate Analysis</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D057216" MajorTopicYN="N">Propensity Score</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D016016" MajorTopicYN="N">Proportional Hazards Models</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D051437" MajorTopicYN="N">Renal Insufficiency</DescriptorName><QualifierName UI="Q000601" MajorTopicYN="Y">surgery</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D012189" MajorTopicYN="N">Retrospective Studies</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D012306" MajorTopicYN="N">Risk</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D020123" MajorTopicYN="N">Sirolimus</DescriptorName><QualifierName UI="Q000627" MajorTopicYN="N">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D013030" MajorTopicYN="N">Spain</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D058570" MajorTopicYN="N">TOR Serine-Threonine Kinases</DescriptorName><QualifierName UI="Q000037" MajorTopicYN="Y">antagonists & inhibitors</QualifierName></MeshHeading></MeshHeadingList><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">cytomegalovirus</Keyword><Keyword MajorTopicYN="N">kidney transplantation</Keyword><Keyword MajorTopicYN="N">mammalian target of rapamycin inhibitors</Keyword><Keyword MajorTopicYN="N">polyclonal anti-lymphocyte globulins</Keyword></KeywordList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2016</Year><Month>05</Month><Day>04</Day></PubMedPubDate><PubMedPubDate PubStatus="revised"><Year>2016</Year><Month>05</Month><Day>13</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2016</Year><Month>08</Month><Day>17</Day></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2016</Year><Month>10</Month><Day>28</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2017</Year><Month>8</Month><Day>5</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate 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