Successful Treatment for BK Virus Nephropathy by Leflunomide in a Kidney Transplant Patient: A Case Report.
Identifieur interne : 000226 ( Main/Exploration ); précédent : 000225; suivant : 000227Successful Treatment for BK Virus Nephropathy by Leflunomide in a Kidney Transplant Patient: A Case Report.
Auteurs : Mei-Yi Wu [Taïwan] ; Yu-Wei Chen [Taïwan] ; Lie-Yee Hung [Taïwan] ; Chii-Hong Lee [Taïwan] ; Hsin-An Chen [Taïwan] ; Yung-Ho Hsu [Taïwan] ; Mai-Szu Wu [Taïwan]Source :
- Transplantation proceedings [ 1873-2623 ] ; 2019.
Descripteurs français
- KwdFr :
- Acide mycophénolique (usage thérapeutique), Adulte d'âge moyen (MeSH), Femelle (MeSH), Humains (MeSH), Immunosuppresseurs (effets indésirables), Infections opportunistes (immunologie), Infections à polyomavirus (immunologie), Infections à virus oncogènes (immunologie), Léflunomide (usage thérapeutique), Néphrite interstitielle (immunologie), Néphrite interstitielle (virologie), Sujet immunodéprimé (MeSH), Transplantation homologue (effets indésirables), Transplantation rénale (effets indésirables), Virus BK (MeSH), Évérolimus (usage thérapeutique).
- MESH :
- effets indésirables : Immunosuppresseurs, Transplantation homologue, Transplantation rénale.
- immunologie : Infections opportunistes, Infections à polyomavirus, Infections à virus oncogènes, Néphrite interstitielle.
- usage thérapeutique : Acide mycophénolique, Léflunomide, Évérolimus.
- virologie : Néphrite interstitielle.
- Adulte d'âge moyen, Femelle, Humains, Sujet immunodéprimé, Virus BK.
English descriptors
- KwdEn :
- BK Virus (MeSH), Everolimus (therapeutic use), Female (MeSH), Humans (MeSH), Immunocompromised Host (MeSH), Immunosuppressive Agents (adverse effects), Kidney Transplantation (adverse effects), Leflunomide (therapeutic use), Middle Aged (MeSH), Mycophenolic Acid (therapeutic use), Nephritis, Interstitial (immunology), Nephritis, Interstitial (virology), Opportunistic Infections (immunology), Polyomavirus Infections (immunology), Transplantation, Homologous (adverse effects), Tumor Virus Infections (immunology).
- MESH :
- chemical , adverse effects : Immunosuppressive Agents.
- chemical , therapeutic use : Everolimus, Leflunomide, Mycophenolic Acid.
- adverse effects : Kidney Transplantation, Transplantation, Homologous.
- immunology : Nephritis, Interstitial, Opportunistic Infections, Polyomavirus Infections, Tumor Virus Infections.
- virology : Nephritis, Interstitial.
- BK Virus, Female, Humans, Immunocompromised Host, Middle Aged.
Abstract
INTRODUCTION
The immunosuppressant agents in kidney transplantation (KT) may lead to various complications such as opportunistic infections and malignancies. BK virus associated nephropathy is a significant complication following KT, and it can result in graft failure. BK virus causes tubulointerstitial nephritis, ureter stenosis, and even graft failure in KT recipients with impaired immune system. We described a 63-year-old woman, who was a hepatitis C carrier and on dialysis for 22 years before KT, who received cadaveric-donor KT 2 years previously. She reported decreasing urine output and general weakness. The serum creatinine level was slightly increased from 2.94 to 4.38 mg/dL.
METHODS
Immunosuppressant medications including prednisolone, everolimus, cyclosporin, and mycophenolate sodium were continued as maintenance therapy post KT. Kidney biopsy was performed due to deterioration of graft function.
RESULTS
The kidney biopsy showed consistent results with early-stage polyomavirus nephropathy, characterized by focal viral cytopathic changes with positive immunohistochemical signals and mesangial proliferative glomerulonephritis, immune-complex-mediated (Fig 1 and Fig 2). Negative C4d staining at peritubular capillary was reported. The dosage of mycophenolate sodium was tapered from 720 to 360 mg daily and that of everolimus increased from 0.5 to 1.0 mg daily due to BK viral infection with BK nephropathy. The serum creatinine level was 2.75 mg/dL after treatment.
CONCLUSION
Early detection of BK nephropathy and decreasing immunosuppressant agents are the mainstay of treatment. Substituting leflunomide for mycophenolate sodium and increasing dosage of everolimus has been proposed to solve BK nephropathy. We presented that the use of leflunomide in such situation is in a timely manner.
DOI: 10.1016/j.transproceed.2019.01.146
PubMed: 31084921
Affiliations:
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Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Primary Care, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.</nlm:affiliation><country xml:lang="fr">Taïwan</country><wicri:regionArea>Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan; Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Primary Care, Shuang Ho Hospital, Taipei Medical University, Taipei</wicri:regionArea><wicri:noRegion>Taipei</wicri:noRegion></affiliation></author><author><name sortKey="Chen, Yu Wei" sort="Chen, Yu Wei" uniqKey="Chen Y" first="Yu-Wei" last="Chen">Yu-Wei Chen</name><affiliation wicri:level="1"><nlm:affiliation>Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan; Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.</nlm:affiliation><country xml:lang="fr">Taïwan</country><wicri:regionArea>Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan; Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei</wicri:regionArea><wicri:noRegion>Taipei</wicri:noRegion></affiliation></author><author><name sortKey="Hung, Lie Yee" sort="Hung, Lie Yee" uniqKey="Hung L" first="Lie-Yee" last="Hung">Lie-Yee Hung</name><affiliation wicri:level="1"><nlm:affiliation>Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.</nlm:affiliation><country xml:lang="fr">Taïwan</country><wicri:regionArea>Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei</wicri:regionArea><wicri:noRegion>Taipei</wicri:noRegion></affiliation></author><author><name sortKey="Lee, Chii Hong" sort="Lee, Chii Hong" uniqKey="Lee C" first="Chii-Hong" last="Lee">Chii-Hong Lee</name><affiliation wicri:level="1"><nlm:affiliation>Department of Pathology, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.</nlm:affiliation><country xml:lang="fr">Taïwan</country><wicri:regionArea>Department of Pathology, Shuang Ho Hospital, Taipei Medical University, Taipei</wicri:regionArea><wicri:noRegion>Taipei</wicri:noRegion></affiliation></author><author><name sortKey="Chen, Hsin An" sort="Chen, Hsin An" uniqKey="Chen H" first="Hsin-An" last="Chen">Hsin-An Chen</name><affiliation wicri:level="1"><nlm:affiliation>Department of General Surgery, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.</nlm:affiliation><country xml:lang="fr">Taïwan</country><wicri:regionArea>Department of General Surgery, Shuang Ho Hospital, Taipei Medical University, Taipei</wicri:regionArea><wicri:noRegion>Taipei</wicri:noRegion></affiliation></author><author><name sortKey="Hsu, Yung Ho" sort="Hsu, Yung Ho" uniqKey="Hsu Y" first="Yung-Ho" last="Hsu">Yung-Ho Hsu</name><affiliation wicri:level="1"><nlm:affiliation>Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan; Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.</nlm:affiliation><country xml:lang="fr">Taïwan</country><wicri:regionArea>Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan; Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei</wicri:regionArea><wicri:noRegion>Taipei</wicri:noRegion></affiliation></author><author><name sortKey="Wu, Mai Szu" sort="Wu, Mai Szu" uniqKey="Wu M" first="Mai-Szu" last="Wu">Mai-Szu Wu</name><affiliation wicri:level="1"><nlm:affiliation>Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan; Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. Electronic address: maiszuwu@gmail.com.</nlm:affiliation><country xml:lang="fr">Taïwan</country><wicri:regionArea>Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan; Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei</wicri:regionArea><wicri:noRegion>Taipei</wicri:noRegion></affiliation></author></analytic><series><title level="j">Transplantation proceedings</title><idno type="eISSN">1873-2623</idno><imprint><date when="2019" type="published">2019</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>BK Virus (MeSH)</term><term>Everolimus (therapeutic use)</term><term>Female (MeSH)</term><term>Humans (MeSH)</term><term>Immunocompromised Host (MeSH)</term><term>Immunosuppressive Agents (adverse effects)</term><term>Kidney Transplantation (adverse effects)</term><term>Leflunomide (therapeutic use)</term><term>Middle Aged (MeSH)</term><term>Mycophenolic Acid (therapeutic use)</term><term>Nephritis, Interstitial (immunology)</term><term>Nephritis, Interstitial (virology)</term><term>Opportunistic Infections (immunology)</term><term>Polyomavirus Infections (immunology)</term><term>Transplantation, Homologous (adverse effects)</term><term>Tumor Virus Infections (immunology)</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Acide mycophénolique (usage thérapeutique)</term><term>Adulte d'âge moyen (MeSH)</term><term>Femelle (MeSH)</term><term>Humains (MeSH)</term><term>Immunosuppresseurs (effets indésirables)</term><term>Infections opportunistes (immunologie)</term><term>Infections à polyomavirus (immunologie)</term><term>Infections à virus oncogènes (immunologie)</term><term>Léflunomide (usage thérapeutique)</term><term>Néphrite interstitielle (immunologie)</term><term>Néphrite interstitielle (virologie)</term><term>Sujet immunodéprimé (MeSH)</term><term>Transplantation homologue (effets indésirables)</term><term>Transplantation rénale (effets indésirables)</term><term>Virus BK (MeSH)</term><term>Évérolimus (usage thérapeutique)</term></keywords><keywords scheme="MESH" type="chemical" qualifier="adverse effects" xml:lang="en"><term>Immunosuppressive Agents</term></keywords><keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Everolimus</term><term>Leflunomide</term><term>Mycophenolic Acid</term></keywords><keywords scheme="MESH" qualifier="adverse effects" xml:lang="en"><term>Kidney Transplantation</term><term>Transplantation, Homologous</term></keywords><keywords scheme="MESH" qualifier="effets indésirables" xml:lang="fr"><term>Immunosuppresseurs</term><term>Transplantation homologue</term><term>Transplantation rénale</term></keywords><keywords scheme="MESH" qualifier="immunologie" xml:lang="fr"><term>Infections opportunistes</term><term>Infections à polyomavirus</term><term>Infections à virus oncogènes</term><term>Néphrite interstitielle</term></keywords><keywords scheme="MESH" qualifier="immunology" xml:lang="en"><term>Nephritis, Interstitial</term><term>Opportunistic Infections</term><term>Polyomavirus Infections</term><term>Tumor Virus Infections</term></keywords><keywords scheme="MESH" qualifier="usage thérapeutique" xml:lang="fr"><term>Acide mycophénolique</term><term>Léflunomide</term><term>Évérolimus</term></keywords><keywords scheme="MESH" qualifier="virologie" xml:lang="fr"><term>Néphrite interstitielle</term></keywords><keywords scheme="MESH" qualifier="virology" xml:lang="en"><term>Nephritis, Interstitial</term></keywords><keywords scheme="MESH" xml:lang="en"><term>BK Virus</term><term>Female</term><term>Humans</term><term>Immunocompromised Host</term><term>Middle Aged</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Adulte d'âge moyen</term><term>Femelle</term><term>Humains</term><term>Sujet immunodéprimé</term><term>Virus BK</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>INTRODUCTION</b></p><p>The immunosuppressant agents in kidney transplantation (KT) may lead to various complications such as opportunistic infections and malignancies. BK virus associated nephropathy is a significant complication following KT, and it can result in graft failure. BK virus causes tubulointerstitial nephritis, ureter stenosis, and even graft failure in KT recipients with impaired immune system. We described a 63-year-old woman, who was a hepatitis C carrier and on dialysis for 22 years before KT, who received cadaveric-donor KT 2 years previously. She reported decreasing urine output and general weakness. The serum creatinine level was slightly increased from 2.94 to 4.38 mg/dL.</p></div><div type="abstract" xml:lang="en"><p><b>METHODS</b></p><p>Immunosuppressant medications including prednisolone, everolimus, cyclosporin, and mycophenolate sodium were continued as maintenance therapy post KT. Kidney biopsy was performed due to deterioration of graft function.</p></div><div type="abstract" xml:lang="en"><p><b>RESULTS</b></p><p>The kidney biopsy showed consistent results with early-stage polyomavirus nephropathy, characterized by focal viral cytopathic changes with positive immunohistochemical signals and mesangial proliferative glomerulonephritis, immune-complex-mediated (Fig 1 and Fig 2). Negative C4d staining at peritubular capillary was reported. The dosage of mycophenolate sodium was tapered from 720 to 360 mg daily and that of everolimus increased from 0.5 to 1.0 mg daily due to BK viral infection with BK nephropathy. The serum creatinine level was 2.75 mg/dL after treatment.</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSION</b></p><p>Early detection of BK nephropathy and decreasing immunosuppressant agents are the mainstay of treatment. Substituting leflunomide for mycophenolate sodium and increasing dosage of everolimus has been proposed to solve BK nephropathy. We presented that the use of leflunomide in such situation is in a timely manner.</p></div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" IndexingMethod="Curated" Owner="NLM"><PMID Version="1">31084921</PMID><DateCompleted><Year>2019</Year><Month>07</Month><Day>22</Day></DateCompleted><DateRevised><Year>2019</Year><Month>07</Month><Day>22</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1873-2623</ISSN><JournalIssue CitedMedium="Internet"><Volume>51</Volume><Issue>5</Issue><PubDate><Year>2019</Year><Month>Jun</Month></PubDate></JournalIssue><Title>Transplantation proceedings</Title><ISOAbbreviation>Transplant Proc</ISOAbbreviation></Journal><ArticleTitle>Successful Treatment for BK Virus Nephropathy by Leflunomide in a Kidney Transplant Patient: A Case Report.</ArticleTitle><Pagination><MedlinePgn>1472-1474</MedlinePgn></Pagination><ELocationID EIdType="pii" ValidYN="Y">S0041-1345(19)30006-5</ELocationID><ELocationID EIdType="doi" ValidYN="Y">10.1016/j.transproceed.2019.01.146</ELocationID><Abstract><AbstractText Label="INTRODUCTION" NlmCategory="BACKGROUND">The immunosuppressant agents in kidney transplantation (KT) may lead to various complications such as opportunistic infections and malignancies. BK virus associated nephropathy is a significant complication following KT, and it can result in graft failure. BK virus causes tubulointerstitial nephritis, ureter stenosis, and even graft failure in KT recipients with impaired immune system. We described a 63-year-old woman, who was a hepatitis C carrier and on dialysis for 22 years before KT, who received cadaveric-donor KT 2 years previously. She reported decreasing urine output and general weakness. The serum creatinine level was slightly increased from 2.94 to 4.38 mg/dL.</AbstractText><AbstractText Label="METHODS" NlmCategory="METHODS">Immunosuppressant medications including prednisolone, everolimus, cyclosporin, and mycophenolate sodium were continued as maintenance therapy post KT. Kidney biopsy was performed due to deterioration of graft function.</AbstractText><AbstractText Label="RESULTS" NlmCategory="RESULTS">The kidney biopsy showed consistent results with early-stage polyomavirus nephropathy, characterized by focal viral cytopathic changes with positive immunohistochemical signals and mesangial proliferative glomerulonephritis, immune-complex-mediated (Fig 1 and Fig 2). Negative C4d staining at peritubular capillary was reported. The dosage of mycophenolate sodium was tapered from 720 to 360 mg daily and that of everolimus increased from 0.5 to 1.0 mg daily due to BK viral infection with BK nephropathy. The serum creatinine level was 2.75 mg/dL after treatment.</AbstractText><AbstractText Label="CONCLUSION" NlmCategory="CONCLUSIONS">Early detection of BK nephropathy and decreasing immunosuppressant agents are the mainstay of treatment. Substituting leflunomide for mycophenolate sodium and increasing dosage of everolimus has been proposed to solve BK nephropathy. We presented that the use of leflunomide in such situation is in a timely manner.</AbstractText><CopyrightInformation>Copyright © 2019 Elsevier Inc. All rights reserved.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Wu</LastName><ForeName>Mei-Yi</ForeName><Initials>MY</Initials><AffiliationInfo><Affiliation>Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan; Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Primary Care, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Chen</LastName><ForeName>Yu-Wei</ForeName><Initials>YW</Initials><AffiliationInfo><Affiliation>Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan; Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Hung</LastName><ForeName>Lie-Yee</ForeName><Initials>LY</Initials><AffiliationInfo><Affiliation>Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Lee</LastName><ForeName>Chii-Hong</ForeName><Initials>CH</Initials><AffiliationInfo><Affiliation>Department of Pathology, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Chen</LastName><ForeName>Hsin-An</ForeName><Initials>HA</Initials><AffiliationInfo><Affiliation>Department of General Surgery, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Hsu</LastName><ForeName>Yung-Ho</ForeName><Initials>YH</Initials><AffiliationInfo><Affiliation>Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan; Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Wu</LastName><ForeName>Mai-Szu</ForeName><Initials>MS</Initials><AffiliationInfo><Affiliation>Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan; Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. Electronic address: maiszuwu@gmail.com.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D002363">Case Reports</PublicationType><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2019</Year><Month>05</Month><Day>10</Day></ArticleDate></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>Transplant Proc</MedlineTA><NlmUniqueID>0243532</NlmUniqueID><ISSNLinking>0041-1345</ISSNLinking></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D007166">Immunosuppressive Agents</NameOfSubstance></Chemical><Chemical><RegistryNumber>9HW64Q8G6G</RegistryNumber><NameOfSubstance UI="D000068338">Everolimus</NameOfSubstance></Chemical><Chemical><RegistryNumber>G162GK9U4W</RegistryNumber><NameOfSubstance UI="D000077339">Leflunomide</NameOfSubstance></Chemical><Chemical><RegistryNumber>HU9DX48N0T</RegistryNumber><NameOfSubstance UI="D009173">Mycophenolic Acid</NameOfSubstance></Chemical></ChemicalList><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D001739" MajorTopicYN="N">BK Virus</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000068338" MajorTopicYN="N">Everolimus</DescriptorName><QualifierName UI="Q000627" MajorTopicYN="N">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D016867" MajorTopicYN="Y">Immunocompromised Host</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D007166" MajorTopicYN="N">Immunosuppressive Agents</DescriptorName><QualifierName UI="Q000009" MajorTopicYN="Y">adverse effects</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D016030" MajorTopicYN="Y">Kidney Transplantation</DescriptorName><QualifierName UI="Q000009" MajorTopicYN="N">adverse effects</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D000077339" MajorTopicYN="N">Leflunomide</DescriptorName><QualifierName UI="Q000627" MajorTopicYN="N">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D009173" MajorTopicYN="N">Mycophenolic Acid</DescriptorName><QualifierName UI="Q000627" MajorTopicYN="N">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D009395" MajorTopicYN="N">Nephritis, Interstitial</DescriptorName><QualifierName UI="Q000276" MajorTopicYN="N">immunology</QualifierName><QualifierName UI="Q000821" MajorTopicYN="N">virology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D009894" MajorTopicYN="N">Opportunistic Infections</DescriptorName><QualifierName UI="Q000276" MajorTopicYN="N">immunology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D027601" MajorTopicYN="N">Polyomavirus Infections</DescriptorName><QualifierName UI="Q000276" MajorTopicYN="Y">immunology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D014184" MajorTopicYN="N">Transplantation, Homologous</DescriptorName><QualifierName UI="Q000009" MajorTopicYN="N">adverse effects</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D014412" MajorTopicYN="N">Tumor Virus Infections</DescriptorName><QualifierName UI="Q000276" MajorTopicYN="Y">immunology</QualifierName></MeshHeading></MeshHeadingList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2019</Year><Month>01</Month><Day>02</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2019</Year><Month>01</Month><Day>28</Day></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2019</Year><Month>5</Month><Day>16</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2019</Year><Month>7</Month><Day>23</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2019</Year><Month>5</Month><Day>16</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">31084921</ArticleId><ArticleId IdType="pii">S0041-1345(19)30006-5</ArticleId><ArticleId IdType="doi">10.1016/j.transproceed.2019.01.146</ArticleId></ArticleIdList></PubmedData></pubmed><affiliations><list><country><li>Taïwan</li></country></list><tree><country name="Taïwan"><noRegion><name sortKey="Wu, Mei Yi" sort="Wu, Mei Yi" uniqKey="Wu M" first="Mei-Yi" last="Wu">Mei-Yi Wu</name></noRegion><name sortKey="Chen, Hsin An" sort="Chen, Hsin An" uniqKey="Chen H" first="Hsin-An" last="Chen">Hsin-An Chen</name><name sortKey="Chen, Yu Wei" sort="Chen, Yu Wei" uniqKey="Chen Y" first="Yu-Wei" last="Chen">Yu-Wei Chen</name><name sortKey="Hsu, Yung Ho" sort="Hsu, Yung Ho" uniqKey="Hsu Y" first="Yung-Ho" last="Hsu">Yung-Ho Hsu</name><name sortKey="Hung, Lie Yee" sort="Hung, Lie Yee" uniqKey="Hung L" first="Lie-Yee" last="Hung">Lie-Yee Hung</name><name sortKey="Lee, Chii Hong" sort="Lee, Chii Hong" uniqKey="Lee C" first="Chii-Hong" last="Lee">Chii-Hong Lee</name><name sortKey="Wu, Mai Szu" sort="Wu, Mai Szu" uniqKey="Wu M" first="Mai-Szu" last="Wu">Mai-Szu Wu</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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