The use of sirolimus in patients with recurrent cytomegalovirus infection after kidney transplantation: A retrospective case series analysis.
Identifieur interne : 000167 ( Main/Exploration ); précédent : 000166; suivant : 000168The use of sirolimus in patients with recurrent cytomegalovirus infection after kidney transplantation: A retrospective case series analysis.
Auteurs : Ali M. Shendi [Égypte] ; Rachel K Y. Hung [Royaume-Uni] ; Ben Caplin [Royaume-Uni] ; Paul Griffiths [Royaume-Uni] ; Mark Harber [Royaume-Uni]Source :
- Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia [ 1319-2442 ]
Descripteurs français
- KwdFr :
- Acide mycophénolique (effets indésirables), Adulte (MeSH), Adulte d'âge moyen (MeSH), Antiviraux (usage thérapeutique), Facteurs de risque (MeSH), Facteurs temps (MeSH), Femelle (MeSH), Humains (MeSH), Immunosuppresseurs (effets indésirables), Immunosuppresseurs (usage thérapeutique), Infections opportunistes (diagnostic), Infections opportunistes (immunologie), Infections opportunistes (traitement médicamenteux), Infections opportunistes (virologie), Infections à cytomégalovirus (diagnostic), Infections à cytomégalovirus (immunologie), Infections à cytomégalovirus (traitement médicamenteux), Infections à cytomégalovirus (virologie), Jeune adulte (MeSH), Mâle (MeSH), Rejet du greffon (immunologie), Rejet du greffon (prévention et contrôle), Récidive (MeSH), Résultat thérapeutique (MeSH), Sirolimus (effets indésirables), Sirolimus (usage thérapeutique), Substitution de médicament (MeSH), Sujet immunodéprimé (MeSH), Sujet âgé (MeSH), Survie du greffon (effets des médicaments et des substances chimiques), Tacrolimus (effets indésirables), Transplantation rénale (effets indésirables), Études rétrospectives (MeSH).
- MESH :
- diagnostic : Infections opportunistes, Infections à cytomégalovirus.
- effets des médicaments et des substances chimiques : Survie du greffon.
- effets indésirables : Acide mycophénolique, Immunosuppresseurs, Sirolimus, Tacrolimus, Transplantation rénale.
- immunologie : Infections opportunistes, Infections à cytomégalovirus, Rejet du greffon.
- prévention et contrôle : Rejet du greffon.
- traitement médicamenteux : Infections opportunistes, Infections à cytomégalovirus.
- usage thérapeutique : Antiviraux, Immunosuppresseurs, Sirolimus.
- virologie : Infections opportunistes, Infections à cytomégalovirus.
- Adulte, Adulte d'âge moyen, Facteurs de risque, Facteurs temps, Femelle, Humains, Jeune adulte, Mâle, Récidive, Résultat thérapeutique, Substitution de médicament, Sujet immunodéprimé, Sujet âgé, Études rétrospectives.
English descriptors
- KwdEn :
- Adult (MeSH), Aged (MeSH), Antiviral Agents (therapeutic use), Cytomegalovirus Infections (diagnosis), Cytomegalovirus Infections (drug therapy), Cytomegalovirus Infections (immunology), Cytomegalovirus Infections (virology), Drug Substitution (MeSH), Female (MeSH), Graft Rejection (immunology), Graft Rejection (prevention & control), Graft Survival (drug effects), Humans (MeSH), Immunocompromised Host (MeSH), Immunosuppressive Agents (adverse effects), Immunosuppressive Agents (therapeutic use), Kidney Transplantation (adverse effects), Male (MeSH), Middle Aged (MeSH), Mycophenolic Acid (adverse effects), Opportunistic Infections (diagnosis), Opportunistic Infections (drug therapy), Opportunistic Infections (immunology), Opportunistic Infections (virology), Recurrence (MeSH), Retrospective Studies (MeSH), Risk Factors (MeSH), Sirolimus (adverse effects), Sirolimus (therapeutic use), Tacrolimus (adverse effects), Time Factors (MeSH), Treatment Outcome (MeSH), Young Adult (MeSH).
- MESH :
- chemical , adverse effects : Immunosuppressive Agents, Mycophenolic Acid, Sirolimus, Tacrolimus.
- chemical , therapeutic use : Antiviral Agents, Immunosuppressive Agents, Sirolimus.
- adverse effects : Kidney Transplantation.
- diagnosis : Cytomegalovirus Infections, Opportunistic Infections.
- drug effects : Graft Survival.
- drug therapy : Cytomegalovirus Infections, Opportunistic Infections.
- immunology : Cytomegalovirus Infections, Graft Rejection, Opportunistic Infections.
- prevention & control : Graft Rejection.
- virology : Cytomegalovirus Infections, Opportunistic Infections.
- Adult, Aged, Drug Substitution, Female, Humans, Immunocompromised Host, Male, Middle Aged, Recurrence, Retrospective Studies, Risk Factors, Time Factors, Treatment Outcome, Young Adult.
Abstract
Cytomegalovirus (CMV) is one of opportunistic infections post solid organ transplant and remains a cause of morbidity and mortality. Mammalian target of rapamycin inhibitors has a theoretical antiviral advantage compared to conventional immunosuppression. The primary outcome was to assess the viremic response and kidney function in a cohort of kidney transplant recipients (KTRs) with difficult to manage CMV infection when converted to sirolimus. We retrospectively analyzed the outcome of substituting sirolimus for mycophenolate mofetil (MMF) or tacrolimus in 18 KTR with difficult to manage, resistant/recurrent CMV viremia unresponsive or intolerant of standard anti-CMV treatment, or immunosuppression reduction. Safety and feasibility of sirolimus conversion were assessed through studying CMV viral loads, creatinine levels, immunosuppression, antiviral therapy, kidney function, and acute rejection episodes before and after starting sirolimus as well as the sirolimus side effects. Data were collected from the hospital filing system. The Wilcoxon matched-pairs signed-rank test and Friedman test were used for statistical analysis. The area under the curve for Log10 CMV viral load (log10 copies/ml) was significantly higher before than after the sirolimus switch (P = 0.0156). The median number of days on antiviral treatment was reduced after conversion to sirolimus [48 days (0-95); vs. 68 days (21-146)]. Acute rejection occurred more commonly before than after starting sirolimus [n =5 (27.7%) vs. n = 2 (11.1%)]. Median serum creatinine before conversion to sirolimus was 175.5 μmol/L (79-243), and showed no deterioration three months and one year after conversion [148 (69-271) and 162.5 (69-287) μmol/L, respectively, P = 0.002]. The use of sirolimus, often alongside tacrolimus and after discontinuation of MMF, is a useful strategy in treating recurrent CMV viremia without provoking rejection.
DOI: 10.4103/1319-2442.261333
PubMed: 31249224
Affiliations:
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Shendi</name><affiliation wicri:level="1"><nlm:affiliation>UCL Department of Renal Medicine, Royal Free London NHS Foundation Trust, London, UK; Department of Internal Medicine, Nephrology Unit, Faculty of Medicine, Zagazig University, Zagazig, Egypt.</nlm:affiliation><country xml:lang="fr">Égypte</country><wicri:regionArea>UCL Department of Renal Medicine, Royal Free London NHS Foundation Trust, London, UK; Department of Internal Medicine, Nephrology Unit, Faculty of Medicine, Zagazig University, Zagazig</wicri:regionArea><wicri:noRegion>Zagazig</wicri:noRegion></affiliation></author><author><name sortKey="Hung, Rachel K Y" sort="Hung, Rachel K Y" uniqKey="Hung R" first="Rachel K Y" last="Hung">Rachel K Y. Hung</name><affiliation wicri:level="3"><nlm:affiliation>UCL Department of Renal Medicine, Royal Free London NHS Foundation Trust, London, UK.</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>UCL Department of Renal Medicine, Royal Free London NHS Foundation Trust, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author><author><name sortKey="Caplin, Ben" sort="Caplin, Ben" uniqKey="Caplin B" first="Ben" last="Caplin">Ben Caplin</name><affiliation wicri:level="3"><nlm:affiliation>UCL Department of Renal Medicine, Royal Free London NHS Foundation Trust, London, UK.</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>UCL Department of Renal Medicine, Royal Free London NHS Foundation Trust, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author><author><name sortKey="Griffiths, Paul" sort="Griffiths, Paul" uniqKey="Griffiths P" first="Paul" last="Griffiths">Paul Griffiths</name><affiliation wicri:level="3"><nlm:affiliation>Division of Infection and Immunity, Center for Virology, Royal Free NHS Trust and UCL Medical School, London, UK.</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Division of Infection and Immunity, Center for Virology, Royal Free NHS Trust and UCL Medical School, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author><author><name sortKey="Harber, Mark" sort="Harber, Mark" uniqKey="Harber M" first="Mark" last="Harber">Mark Harber</name><affiliation wicri:level="3"><nlm:affiliation>UCL Department of Renal Medicine, Royal Free London NHS Foundation Trust, London, UK.</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>UCL Department of Renal Medicine, Royal Free London NHS Foundation Trust, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author></analytic><series><title level="j">Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia</title><idno type="ISSN">1319-2442</idno></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult (MeSH)</term><term>Aged (MeSH)</term><term>Antiviral Agents (therapeutic use)</term><term>Cytomegalovirus Infections (diagnosis)</term><term>Cytomegalovirus Infections (drug therapy)</term><term>Cytomegalovirus Infections (immunology)</term><term>Cytomegalovirus Infections (virology)</term><term>Drug Substitution (MeSH)</term><term>Female (MeSH)</term><term>Graft Rejection (immunology)</term><term>Graft Rejection (prevention & control)</term><term>Graft Survival (drug effects)</term><term>Humans (MeSH)</term><term>Immunocompromised Host (MeSH)</term><term>Immunosuppressive Agents (adverse effects)</term><term>Immunosuppressive Agents (therapeutic use)</term><term>Kidney Transplantation (adverse effects)</term><term>Male (MeSH)</term><term>Middle Aged (MeSH)</term><term>Mycophenolic Acid (adverse effects)</term><term>Opportunistic Infections (diagnosis)</term><term>Opportunistic Infections (drug therapy)</term><term>Opportunistic Infections (immunology)</term><term>Opportunistic Infections (virology)</term><term>Recurrence (MeSH)</term><term>Retrospective Studies (MeSH)</term><term>Risk Factors (MeSH)</term><term>Sirolimus (adverse effects)</term><term>Sirolimus (therapeutic use)</term><term>Tacrolimus (adverse effects)</term><term>Time Factors (MeSH)</term><term>Treatment Outcome (MeSH)</term><term>Young Adult (MeSH)</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Acide mycophénolique (effets indésirables)</term><term>Adulte (MeSH)</term><term>Adulte d'âge moyen (MeSH)</term><term>Antiviraux (usage thérapeutique)</term><term>Facteurs de risque (MeSH)</term><term>Facteurs temps (MeSH)</term><term>Femelle (MeSH)</term><term>Humains (MeSH)</term><term>Immunosuppresseurs (effets indésirables)</term><term>Immunosuppresseurs (usage thérapeutique)</term><term>Infections opportunistes (diagnostic)</term><term>Infections opportunistes (immunologie)</term><term>Infections opportunistes (traitement médicamenteux)</term><term>Infections opportunistes (virologie)</term><term>Infections à cytomégalovirus (diagnostic)</term><term>Infections à cytomégalovirus (immunologie)</term><term>Infections à cytomégalovirus (traitement médicamenteux)</term><term>Infections à cytomégalovirus (virologie)</term><term>Jeune adulte (MeSH)</term><term>Mâle (MeSH)</term><term>Rejet du greffon (immunologie)</term><term>Rejet du greffon (prévention et contrôle)</term><term>Récidive (MeSH)</term><term>Résultat thérapeutique (MeSH)</term><term>Sirolimus (effets indésirables)</term><term>Sirolimus (usage thérapeutique)</term><term>Substitution de médicament (MeSH)</term><term>Sujet immunodéprimé (MeSH)</term><term>Sujet âgé (MeSH)</term><term>Survie du greffon (effets des médicaments et des substances chimiques)</term><term>Tacrolimus (effets indésirables)</term><term>Transplantation rénale (effets indésirables)</term><term>Études rétrospectives (MeSH)</term></keywords><keywords scheme="MESH" type="chemical" qualifier="adverse effects" xml:lang="en"><term>Immunosuppressive Agents</term><term>Mycophenolic Acid</term><term>Sirolimus</term><term>Tacrolimus</term></keywords><keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Antiviral Agents</term><term>Immunosuppressive Agents</term><term>Sirolimus</term></keywords><keywords scheme="MESH" qualifier="adverse effects" xml:lang="en"><term>Kidney Transplantation</term></keywords><keywords scheme="MESH" qualifier="diagnosis" xml:lang="en"><term>Cytomegalovirus Infections</term><term>Opportunistic Infections</term></keywords><keywords scheme="MESH" qualifier="diagnostic" xml:lang="fr"><term>Infections opportunistes</term><term>Infections à cytomégalovirus</term></keywords><keywords scheme="MESH" qualifier="drug effects" xml:lang="en"><term>Graft Survival</term></keywords><keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>Cytomegalovirus Infections</term><term>Opportunistic Infections</term></keywords><keywords scheme="MESH" qualifier="effets des médicaments et des substances chimiques" xml:lang="fr"><term>Survie du greffon</term></keywords><keywords scheme="MESH" qualifier="effets indésirables" xml:lang="fr"><term>Acide mycophénolique</term><term>Immunosuppresseurs</term><term>Sirolimus</term><term>Tacrolimus</term><term>Transplantation rénale</term></keywords><keywords scheme="MESH" qualifier="immunologie" xml:lang="fr"><term>Infections opportunistes</term><term>Infections à cytomégalovirus</term><term>Rejet du greffon</term></keywords><keywords scheme="MESH" qualifier="immunology" xml:lang="en"><term>Cytomegalovirus Infections</term><term>Graft Rejection</term><term>Opportunistic Infections</term></keywords><keywords scheme="MESH" qualifier="prevention & control" xml:lang="en"><term>Graft Rejection</term></keywords><keywords scheme="MESH" qualifier="prévention et contrôle" xml:lang="fr"><term>Rejet du greffon</term></keywords><keywords scheme="MESH" qualifier="traitement médicamenteux" xml:lang="fr"><term>Infections opportunistes</term><term>Infections à cytomégalovirus</term></keywords><keywords scheme="MESH" qualifier="usage thérapeutique" xml:lang="fr"><term>Antiviraux</term><term>Immunosuppresseurs</term><term>Sirolimus</term></keywords><keywords scheme="MESH" qualifier="virologie" xml:lang="fr"><term>Infections opportunistes</term><term>Infections à cytomégalovirus</term></keywords><keywords scheme="MESH" qualifier="virology" xml:lang="en"><term>Cytomegalovirus Infections</term><term>Opportunistic Infections</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adult</term><term>Aged</term><term>Drug Substitution</term><term>Female</term><term>Humans</term><term>Immunocompromised Host</term><term>Male</term><term>Middle Aged</term><term>Recurrence</term><term>Retrospective Studies</term><term>Risk Factors</term><term>Time Factors</term><term>Treatment Outcome</term><term>Young Adult</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Adulte</term><term>Adulte d'âge moyen</term><term>Facteurs de risque</term><term>Facteurs temps</term><term>Femelle</term><term>Humains</term><term>Jeune adulte</term><term>Mâle</term><term>Récidive</term><term>Résultat thérapeutique</term><term>Substitution de médicament</term><term>Sujet immunodéprimé</term><term>Sujet âgé</term><term>Études rétrospectives</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Cytomegalovirus (CMV) is one of opportunistic infections post solid organ transplant and remains a cause of morbidity and mortality. Mammalian target of rapamycin inhibitors has a theoretical antiviral advantage compared to conventional immunosuppression. The primary outcome was to assess the viremic response and kidney function in a cohort of kidney transplant recipients (KTRs) with difficult to manage CMV infection when converted to sirolimus. We retrospectively analyzed the outcome of substituting sirolimus for mycophenolate mofetil (MMF) or tacrolimus in 18 KTR with difficult to manage, resistant/recurrent CMV viremia unresponsive or intolerant of standard anti-CMV treatment, or immunosuppression reduction. Safety and feasibility of sirolimus conversion were assessed through studying CMV viral loads, creatinine levels, immunosuppression, antiviral therapy, kidney function, and acute rejection episodes before and after starting sirolimus as well as the sirolimus side effects. Data were collected from the hospital filing system. The Wilcoxon matched-pairs signed-rank test and Friedman test were used for statistical analysis. The area under the curve for Log10 CMV viral load (log10 copies/ml) was significantly higher before than after the sirolimus switch (P = 0.0156). The median number of days on antiviral treatment was reduced after conversion to sirolimus [48 days (0-95); vs. 68 days (21-146)]. Acute rejection occurred more commonly before than after starting sirolimus [n =5 (27.7%) vs. n = 2 (11.1%)]. Median serum creatinine before conversion to sirolimus was 175.5 μmol/L (79-243), and showed no deterioration three months and one year after conversion [148 (69-271) and 162.5 (69-287) μmol/L, respectively, P = 0.002]. The use of sirolimus, often alongside tacrolimus and after discontinuation of MMF, is a useful strategy in treating recurrent CMV viremia without provoking rejection.</div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">31249224</PMID><DateCompleted><Year>2020</Year><Month>01</Month><Day>07</Day></DateCompleted><DateRevised><Year>2020</Year><Month>01</Month><Day>07</Day></DateRevised><Article PubModel="Print"><Journal><ISSN IssnType="Print">1319-2442</ISSN><JournalIssue CitedMedium="Internet"><Volume>30</Volume><Issue>3</Issue><PubDate><MedlineDate>2019 May-Jun</MedlineDate></PubDate></JournalIssue><Title>Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia</Title><ISOAbbreviation>Saudi J Kidney Dis Transpl</ISOAbbreviation></Journal><ArticleTitle>The use of sirolimus in patients with recurrent cytomegalovirus infection after kidney transplantation: A retrospective case series analysis.</ArticleTitle><Pagination><MedlinePgn>606-614</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.4103/1319-2442.261333</ELocationID><Abstract><AbstractText>Cytomegalovirus (CMV) is one of opportunistic infections post solid organ transplant and remains a cause of morbidity and mortality. Mammalian target of rapamycin inhibitors has a theoretical antiviral advantage compared to conventional immunosuppression. The primary outcome was to assess the viremic response and kidney function in a cohort of kidney transplant recipients (KTRs) with difficult to manage CMV infection when converted to sirolimus. We retrospectively analyzed the outcome of substituting sirolimus for mycophenolate mofetil (MMF) or tacrolimus in 18 KTR with difficult to manage, resistant/recurrent CMV viremia unresponsive or intolerant of standard anti-CMV treatment, or immunosuppression reduction. Safety and feasibility of sirolimus conversion were assessed through studying CMV viral loads, creatinine levels, immunosuppression, antiviral therapy, kidney function, and acute rejection episodes before and after starting sirolimus as well as the sirolimus side effects. Data were collected from the hospital filing system. The Wilcoxon matched-pairs signed-rank test and Friedman test were used for statistical analysis. The area under the curve for Log10 CMV viral load (log10 copies/ml) was significantly higher before than after the sirolimus switch (P = 0.0156). The median number of days on antiviral treatment was reduced after conversion to sirolimus [48 days (0-95); vs. 68 days (21-146)]. Acute rejection occurred more commonly before than after starting sirolimus [n =5 (27.7%) vs. n = 2 (11.1%)]. Median serum creatinine before conversion to sirolimus was 175.5 μmol/L (79-243), and showed no deterioration three months and one year after conversion [148 (69-271) and 162.5 (69-287) μmol/L, respectively, P = 0.002]. The use of sirolimus, often alongside tacrolimus and after discontinuation of MMF, is a useful strategy in treating recurrent CMV viremia without provoking rejection.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Shendi</LastName><ForeName>Ali M</ForeName><Initials>AM</Initials><AffiliationInfo><Affiliation>UCL Department of Renal Medicine, Royal Free London NHS Foundation Trust, London, UK; Department of Internal Medicine, Nephrology Unit, Faculty of Medicine, Zagazig University, Zagazig, Egypt.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Hung</LastName><ForeName>Rachel K Y</ForeName><Initials>RKY</Initials><AffiliationInfo><Affiliation>UCL Department of Renal Medicine, Royal Free London NHS Foundation Trust, London, UK.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Caplin</LastName><ForeName>Ben</ForeName><Initials>B</Initials><AffiliationInfo><Affiliation>UCL Department of Renal Medicine, Royal Free London NHS Foundation Trust, London, UK.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Griffiths</LastName><ForeName>Paul</ForeName><Initials>P</Initials><AffiliationInfo><Affiliation>Division of Infection and Immunity, Center for Virology, Royal Free NHS Trust and UCL Medical School, London, UK.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Harber</LastName><ForeName>Mark</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>UCL Department of Renal Medicine, Royal Free London NHS Foundation Trust, London, UK.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList></Article><MedlineJournalInfo><Country>Saudi Arabia</Country><MedlineTA>Saudi J Kidney Dis Transpl</MedlineTA><NlmUniqueID>9436968</NlmUniqueID><ISSNLinking>1319-2442</ISSNLinking></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D000998">Antiviral Agents</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D007166">Immunosuppressive Agents</NameOfSubstance></Chemical><Chemical><RegistryNumber>HU9DX48N0T</RegistryNumber><NameOfSubstance UI="D009173">Mycophenolic Acid</NameOfSubstance></Chemical><Chemical><RegistryNumber>W36ZG6FT64</RegistryNumber><NameOfSubstance UI="D020123">Sirolimus</NameOfSubstance></Chemical><Chemical><RegistryNumber>WM0HAQ4WNM</RegistryNumber><NameOfSubstance UI="D016559">Tacrolimus</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="D000998" MajorTopicYN="N">Antiviral Agents</DescriptorName><QualifierName UI="Q000627" MajorTopicYN="Y">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D003586" MajorTopicYN="N">Cytomegalovirus Infections</DescriptorName><QualifierName UI="Q000175" MajorTopicYN="N">diagnosis</QualifierName><QualifierName UI="Q000188" MajorTopicYN="Y">drug therapy</QualifierName><QualifierName UI="Q000276" MajorTopicYN="N">immunology</QualifierName><QualifierName UI="Q000821" MajorTopicYN="N">virology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D057915" MajorTopicYN="N">Drug Substitution</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006084" MajorTopicYN="N">Graft Rejection</DescriptorName><QualifierName UI="Q000276" MajorTopicYN="N">immunology</QualifierName><QualifierName UI="Q000517" MajorTopicYN="N">prevention & control</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006085" MajorTopicYN="N">Graft Survival</DescriptorName><QualifierName UI="Q000187" MajorTopicYN="N">drug effects</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D016867" MajorTopicYN="N">Immunocompromised Host</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D007166" MajorTopicYN="N">Immunosuppressive Agents</DescriptorName><QualifierName UI="Q000009" MajorTopicYN="N">adverse effects</QualifierName><QualifierName UI="Q000627" MajorTopicYN="Y">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D016030" MajorTopicYN="N">Kidney Transplantation</DescriptorName><QualifierName UI="Q000009" MajorTopicYN="Y">adverse effects</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D009173" MajorTopicYN="N">Mycophenolic Acid</DescriptorName><QualifierName UI="Q000009" MajorTopicYN="N">adverse effects</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D009894" MajorTopicYN="N">Opportunistic Infections</DescriptorName><QualifierName UI="Q000175" MajorTopicYN="N">diagnosis</QualifierName><QualifierName UI="Q000188" MajorTopicYN="Y">drug therapy</QualifierName><QualifierName UI="Q000276" MajorTopicYN="N">immunology</QualifierName><QualifierName UI="Q000821" MajorTopicYN="N">virology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D012008" MajorTopicYN="N">Recurrence</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D012189" MajorTopicYN="N">Retrospective Studies</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D012307" MajorTopicYN="N">Risk Factors</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D020123" MajorTopicYN="N">Sirolimus</DescriptorName><QualifierName UI="Q000009" MajorTopicYN="N">adverse effects</QualifierName><QualifierName UI="Q000627" MajorTopicYN="Y">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D016559" MajorTopicYN="N">Tacrolimus</DescriptorName><QualifierName UI="Q000009" MajorTopicYN="N">adverse effects</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D013997" MajorTopicYN="N">Time Factors</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D016896" MajorTopicYN="N">Treatment Outcome</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D055815" MajorTopicYN="N">Young Adult</DescriptorName></MeshHeading></MeshHeadingList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="entrez"><Year>2019</Year><Month>6</Month><Day>29</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2019</Year><Month>6</Month><Day>30</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2020</Year><Month>1</Month><Day>8</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">31249224</ArticleId><ArticleId IdType="pii">SaudiJKidneyDisTranspl_2019_30_3_606_261333</ArticleId><ArticleId IdType="doi">10.4103/1319-2442.261333</ArticleId></ArticleIdList></PubmedData></pubmed><affiliations><list><country><li>Royaume-Uni</li><li>Égypte</li></country><region><li>Angleterre</li><li>Grand Londres</li></region><settlement><li>Londres</li></settlement></list><tree><country name="Égypte"><noRegion><name sortKey="Shendi, Ali M" sort="Shendi, Ali M" uniqKey="Shendi A" first="Ali M" last="Shendi">Ali M. Shendi</name></noRegion></country><country name="Royaume-Uni"><region name="Angleterre"><name sortKey="Hung, Rachel K Y" sort="Hung, Rachel K Y" uniqKey="Hung R" first="Rachel K Y" last="Hung">Rachel K Y. Hung</name></region><name sortKey="Caplin, Ben" sort="Caplin, Ben" uniqKey="Caplin B" first="Ben" last="Caplin">Ben Caplin</name><name sortKey="Griffiths, Paul" sort="Griffiths, Paul" uniqKey="Griffiths P" first="Paul" last="Griffiths">Paul Griffiths</name><name sortKey="Harber, Mark" sort="Harber, Mark" uniqKey="Harber M" first="Mark" last="Harber">Mark Harber</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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