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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">It has been estimated that during the course of their disease 60&#37; of patients with systemic lupus erythmatosus &#40;SLE&#41; will present with some level of nephritis&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">1</span></a> Despite the fact that in the last few decades treatment and prognosis of lupus nephritis &#40;LN&#41;&#44; has improved&#44; between approximately 10&#37; and 30&#37; of patients develop end-stage renal disease &#40;ESRD&#41;&#44;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">1&#8211;3</span></a> which requires kidney replacement therapy&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Initially SLE was considered a contraindication for kidney transplant &#40;KT&#41; due to the high probability of recurrence of LN &#40;RLN&#41; and to high morbidity&#46; This opinion changed in 1975 when the Advisory Committee to the Renal Transplantation Registry of the American College of Surgeons &#40;ACS&#41; and the National Institute of Health &#40;NIH&#41; concluded that KT in lupus was successful and with similar outcomes to those obtained with the more common causes of ESRD&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">4</span></a> From then onwards&#44; KT began to be considered a reasonable treatment option&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">It is believed that ethnic&#47;racial differences are a determining factor in the outcome of NL&#46; Women with Hispanic and Afro-American origins are at higher risk of progression to ESRD when compared with Caucasians&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">5</span></a> Low socio-economic status&#44; the Afro-American race and people of Hispanic&#47;Latin American origin at greater risk of kidney graft loss&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">6&#44;7</span></a> The Afro-Americans have a lower kidney graft survival rate compared with Hispanics&#44; particularly due to a higher rate of graft rejection from cadaveric donor&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">7</span></a> In people from Latin American countries&#44; observational studies which have compared survival of the graft with other causes of ESRD report a similar graft survival to that of comparison groups&#44;<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">8&#8211;10</span></a> and in the study in Brazil which included mainly Caucasian individuals &#40;91&#37;&#41; they reported better survival of the graft in the group with SLE&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">11</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In transplant centres the frequency of KT in patients with SLE varies between &#46;01&#37; and 5&#46;5&#37; of all KT&#46;<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">9&#44;12&#8211;16</span></a> Survival of the graft is a subject of great interest due to the long-term prognosis of the graft and the rate of RLN continuing to be a controversial point&#46;<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">4&#44;17&#44;18</span></a> The aim of our study was to compare survival of the kidney graft in patients transplanted by LN with other causes of ESRD&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">A retrospective cohort study&#46; Patients who met with the SLE classification from the Americano College of Rheumatology<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">19</span></a> were included and who had undergone a KT for LN in 2 third-tier hospitals&#44; during the period between 1st January 1991 and 31st May 2010 in the Centro M&#233;dico Nacional &#40;CMN&#41; Siglo XXI &#40;CMN SXXI&#41;&#44; and during the period from January 2003 to December 2014 in the CMN &#8220;La Raza&#8221;&#46; Graft loss was defined by the need for dialysis or creatinine &#62;5<span class="elsevierStyleHsp" style=""></span>mg&#47;dl in 2 tests&#46; Patients with diabetes or who had had transplants due to another autoimmune diseases were excluded&#46; To assess if survival difference from other causes of lo ESRD&#44; 2 controls were selected for each patient with SLE&#44; chosen randomly from the KT patient database&#44; paired by age&#44; gender and date of transplant&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Statistical Analysis</span><p id="par0030" class="elsevierStylePara elsevierViewall">The results obtained are presented in the form of the absolute number of cases and their percentage &#40;<span class="elsevierStyleItalic">n</span> &#91;&#37;&#93;&#41; for categorical variables&#44; and the mean with its standard deviation &#40;mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41; for continuous variables with normal distribution and the median with its interquartile range &#40;IQR&#41; for continuous variables which do not follow this distribution&#46; For comparison of categorical variables in accordance with the study group&#44; the Pearson Chi-square test was used or the Fisher exact test&#46; Graft survival was analysed with the Kaplan&#8211;Meier method and the survival curves were compared with the log-rank test&#46; To analyse the variables which impacted the graft loss rate depending on time we used Cox&#39;s proportional risk model which controlled the covariables believed to be probable factors of confusion&#58; disease status &#40;SLE compared with control&#41;&#44; type of transplant&#44; age of transplant&#44; dialysis time&#44; post-transplant thrombosis&#44; acute rejection&#44; chronic graft nephropathy and immunosuppressant treatment used&#46; The validity of each model was assessed with the Shoenfield residuals test method&#46; A <span class="elsevierStyleItalic">P</span> value of &#60;&#46;05 was considered statistically significant&#46; The statistical programme Stata-13 &#40;StataCorp&#46; 2013&#46; Stata-13 Statistical Software&#58; Release 13&#46; College Station&#44; TX&#58; StataCorp LP&#41; was used for statistical analysis&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Results</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Characteristics of the Population Under Study</span><p id="par0035" class="elsevierStylePara elsevierViewall">During the study period 1749 kidney transplants were made in the CMN SXXI&#44; 13 were patients with SLE &#40;&#46;8&#37;&#41; and 4 cases were eliminated due to incomplete information&#46; In the &#8220;La Raza&#8221; CMN 16 kidney transplants were performed in subjects with SLE&#46; The final sample comprised 25 patients with SLE&#44; 5 of whom were SLE of young-age onset&#44; the first transplant was performed in 1993 and the last in 2014&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Median age at diagnosis of SLE was 20&#46;5 years &#40;IQR 8 years&#44; minimum 10 and maximum 50&#41;&#46; Most of the patients were women &#40;19 &#91;76&#37;&#93;&#41;&#44; median age at time of transplant was 27 years &#40;IQR 13&#59; minimum 20&#44; maximum 52&#41;&#46; No significant differences &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41; were observed when comparing the general characteristics between the groups studied&#46; Median therapy duration time for replacement of kidney function was 24 months &#40;IQR 36&#59; minimum 0&#44; maximum 72&#41; in the group with SLE and 26&#46;5 months &#40;IQR 27&#59; minimum 0&#44; maximum 95&#41; in the comparison group&#59; this difference was not statistically significant &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;67&#41;&#46; The most frequent type of kidney replacement prior to transplant in both groups was peritoneal dialysis&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">In subjects with SLE graft origin was mainly &#40;84&#37;&#41; from a live donor who was a relative and in no case was SLE activity present during transplant or was there any hepatitis C virus infection&#46; None of the patients had a secondary antiphospholipid syndrome &#40;APS&#41;&#46; In 7 of the 25 patients at least one determination of aniphosphlipid antibodies &#40;APA&#41; was performed and all tested negative&#46; Prednisone &#40;92&#37;&#41;&#44; mycophenolic acid &#40;76&#37;&#41; and tacrolimus &#40;48&#37;&#41; were the most commonly used immunosuppressants after transplant&#46; In the comparison group there was a higher rate of systemic high blood pressure &#40;96&#37; vs 84&#37;&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;09&#41;&#46; Median post-transplant follow-up time was 34 months &#40;IQR 27&#41; for patients with SLE and 36 months &#40;IQR 48&#41; for patients of the control group&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Kidney Graft Outcomes</span><p id="par0050" class="elsevierStylePara elsevierViewall">Survival probability calculated using the Kaplan&#8211;Meier &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41; method on comparing patients with LN and yearly controls &#40;92&#37; compared with 95&#37;&#41;&#44; 2 years &#40;87&#37; compared with 85&#37;&#41;&#44; 5 years &#40;66&#37; compared with 87&#37;&#41; and 10 years &#40;66&#37; compared with 65&#37;&#41; was similar&#46; The log-rank test did not show any significant difference in survival over time &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;39&#41;&#46; Survival proportion adjusted to death&#44; estimated at 1&#44; 5&#44; and 10 years was 93&#37;&#44; 72&#37; and 72&#37;&#44; respectively&#44; in the LN group and 97&#37;&#44; 83&#37; and 66&#37;&#44; respectively in the comparison group&#46; In multivariate analysis there was no significant difference in survival of the graft between the 2 groups &#40;hazard ratio &#91;HR&#93;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;95&#44; 95&#37; CI&#44; &#46;57&#8211;6&#46;61&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;28&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">When comparing the group of patients with SLE and the control group no statistically significant differences were observed in graft loss &#40;6 &#91;24&#37;&#93; vs 8 &#91;16&#37;&#93;&#44; OR 1&#46;65 &#91;95&#37; CI&#44; &#46;5&#8211;5&#46;44&#93;&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;53&#41;&#44; the frequency of acute rejection &#40;4 &#91;16&#37;&#93; vs 7 &#91;14&#37;&#93;&#44; OR 1&#46;17 &#91;95&#37; CI&#44; &#46;3&#8211;4&#46;45&#93;&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;81&#41; and chronic nephropathy of transplant &#40;6 &#91;24&#37;&#93; vs 15 &#91;30&#37;&#93;&#44; OR 0&#46;73 &#91;95&#37; CI&#44; &#46;24&#8211;2&#46;21&#93;&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;78&#41; and deaths &#40;2 &#91;8&#37;&#93; vs 2 &#91;4&#37;&#93;&#44; OR 2&#46;08 &#91;95&#37; CI&#44; &#46;27&#8211;15&#46;7&#93;&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;59&#41;&#46; The reasons associated with graft loss per group are contained in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46; As a protocol of the institution&#44; early or late dysfunction of the graft led to diagnostic biopsy to establish changes in the immunosuppressant regime or detect dysfunction of the graft or other reasons&#46; In the SLE group 12 cases presented and 18 in the control group&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">In the cohort analysis of patients with SLE&#44; the year in which the transplant was performed did not have any significant impact on the frequency of graft loss &#40;0 losses in 2 KT between 1990 and 1999&#44; 3 in 10 KT between 2000 and 2009 and 3 out of 7 KT between 2010 and 2015&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;65&#41;&#46; The number of shared haplotypes between the donor and recipient was not associated with graft loss &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;19&#41; in analysis of the 9 patients where information was present &#40;2 with graft loss and 7 without&#41;&#46; Of the 4 patients &#40;16&#37;&#41; with SLE who presented with episodes of acute rejection&#44; one patient presented with acute vascular rejection in addition to venous thrombosis of the graft&#44; one patient presented with acute grade IA rejection and 3 presented with acute grade IIA rejection fro Banff classification&#46; The outcomes of these patients were&#58; one developed chronic nephropathy from the graft&#44; one continued with a functional renal graft and the other presented with RLN&#46; The patient who presented with acute vascular rejection and thrombosis of the renal vein 6 days after transplant was treated with pulsed methylprednisolone and thymoglobulin&#46; It was not possible to prevent graft loss&#59; this patient had a background of deep vein thrombosis prior to transplant without APA and received perioperative anticoagulation&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Biopsies of two patients &#40;8&#37;&#41; reported renal RLN of diffuse type in the graft&#46; One patient presented with proteinuria in nephritic ranges due to class IV LN of the International Society of Nephrology&#47;Renal Pathology Society &#40;ISN&#47;RPS&#41; classification&#44; which was treated with an increase in the dose of glucocorticoids and immunosuppressants&#44; obtaining remission of the activity without any loss of graft&#46; The other patient was treated with cyclophosphamode intravenously with remission of the LN&#44; and later developed chronic nephopathy of the graft and finally loss of the graft 16 months after transplant&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">In the cohort of patients with SLE in the multivariate model dialysis time &#40;HR &#46;99&#44; 95&#37; CI&#44; &#46;96&#8211;1&#46;03&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;95&#41;&#44; graft type &#40;HR 1&#46;38&#44; 95&#37; CI&#44; &#46;42&#8211;4&#46;57&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;59&#41;&#44; the presence of young-age onset SLE &#40;HR 2&#46;34&#44; 95&#37; CI&#44; &#46;32&#8211;16&#46;88&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;39&#41;&#44; chronic nephropathy of the graft &#40;HR 1&#46;25&#44; 95&#37; CI&#44; &#46;22&#8211;6&#46;93&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;79&#41; and RLN &#40;HR 2&#46;14&#44; 95&#37; CI&#44; &#46;24&#8211;18&#46;42&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;48&#41; did not predict graft loss&#46; The model which best explained graft loss in patients with SLE was comprised by acute rejection variables &#40;HR 16&#46;5&#44; 95&#37; CI&#44; 1&#46;94&#8211;140&#46;1&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;01&#41;&#44; use of mycophenolic acid &#40;HR 0&#46;3&#44; 95&#37; CI&#44; &#46;04&#8211;2&#46;31&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;25&#41; and cyclosporine A &#40;HR &#46;22&#44; 95&#37; CI&#44; &#46;02&#8211;2&#46;01&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;18&#41;&#59; the last 2 variables have a protective effect but without obtaining any statistical significance&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discussion</span><p id="par0075" class="elsevierStylePara elsevierViewall">In our study&#44; overall survival of the graft using Kaplan&#8211;Meier curve assessment demonstrated that the survival rate was similar to the comparison group&#46; However&#44; after adjusting for possible factors of confusion&#44; the receptors with SLE demonstrated an increase in the risk of 95&#37; of graft loss compared with the control group&#44; but this difference was not statistically significant&#44; which could be due to the low statistical strength of the study and future research is required with a larger number of subjects to rule out this possibility&#46; The importance of adjustment of possible confusing variables comes from the fact that risk may change when they are included in analysis&#46; In the study by Chelamcharla et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">20</span></a> better survival of the graft was found in the subjects with SLE in the Kaplan&#8211;Meier analysis but the multivariate analysis demonstrated a worse outcome&#46; In contrast&#44; Ward<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">21</span></a> found in the univariate analysis that there was a risk of graft loss which was considerably higher in the SLE patients but the risk was similar in the multivariate analysis&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Most studies which compare survival between SLE patients with other causes of kidney disease report a similar survival rate between the groups&#44;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">3&#44;10&#44;22&#8211;29</span></a> although others report a lower survival of the graft and slightly higher rates of graft rejection in subjects with SLE&#46;<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">13&#44;20&#44;30&#44;31</span></a> This discordance may be due both to the population included and to different follow-up times&#44; to heterogeneity in comparison group selection &#40;historic controls&#44; inclusion or not of diabetics&#44; different SLE glomerulonephritis or all of the causes of ESRD without SLE&#41;&#44; or the year of publication&#46; Survival in 1975 at 2 years was 66&#37;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">4</span></a>&#59; in the nineties 5 and 10 year survival rates were 68&#37;&#8211;81&#46;7&#37;&#44; 45&#46;9&#37;&#8211;80&#37; and 18&#46;5&#37;&#44; respectively&#44;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">13</span></a> and in the last decade this has increased to 89&#46;5&#37;&#8211;100&#37;&#44; 67&#37;&#8211;93&#37; and 57&#37;&#8211;86&#37;&#44;<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">13&#44;18&#44;24</span></a> respectively&#46; Survival at 15 and 20 years is now 62&#37;&#8211;73&#37;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">3&#44;24&#44;28</span></a> and 33&#37;&#8211;52&#37;&#44;<a class="elsevierStyleCrossRefs" href="#bib0335"><span class="elsevierStyleSup">20&#44;24</span></a> respectively&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">In studies with Latin American patients graft survival is similar to the comparison groups&#46;<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">8&#44;9</span></a> In Colombian subjects&#44; reported survival is 92&#37;&#8211;96&#37; at one year&#44; 82&#37;&#8211;83&#37; at 5 years and 71&#37; at 15 years<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">8&#44;10</span></a>&#59; for Mexican subjects it is 94&#37; at one year&#44; 74&#37;&#8211;79&#46;9&#37; at 5 years and 73&#37; at 10 years<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">32</span></a>&#59; and in Brazilian subjects it is 93&#37; at one year&#44; 80&#37;&#8211;90&#46;9&#37; at 5 years and 68&#37;&#8211;85&#46;7&#37; at 10 years&#46;<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">11&#44;17&#44;18</span></a> The RLN would vary between 0 and 54&#37; in the studies<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">3&#44;18&#44;33</span></a>&#59; this wide range may be due to ethnicity and whether the biopsy was performed by protocol or due to medical indication&#46; The clinically significant recurrence in the studies was found to be between 2&#37; and 19&#37;&#44;<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">4&#44;6&#44;22&#44;23&#44;29</span></a> and by protocol between 30&#37; and 54&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">3&#44;28</span></a> In Latin American countries&#44; the RLN according to the country of study was&#58; Mexico 4&#37;&#8211;7&#46;4&#37;<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">9&#44;32</span></a>&#59; Colombia 3&#37;<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">8&#44;10</span></a> and Brazil 0&#37;&#8211;11&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">11&#44;18</span></a> Although RLN increases the risk of graft failure&#44; only 2&#37;&#8211;7&#37; of graft losses are attributable to this&#44; compared with 43&#37; attributable to rejection&#46;<a class="elsevierStyleCrossRefs" href="#bib0380"><span class="elsevierStyleSup">29&#44;31&#44;34</span></a> Similarly to our results&#44; acute rejection is a factor significantly associated with graft loss in patients with SLE&#44; although risk of acute rejection is no different from the comparison group risk&#46;<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">8&#44;32</span></a> The frequency of acute rejection in patients with SLE varies between studies&#46; Some report a higher rate&#46;<a class="elsevierStyleCrossRefs" href="#bib0375"><span class="elsevierStyleSup">28&#44;35</span></a> others report a similar frequency to the comparison group<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">3&#44;20&#44;21&#44;30</span></a> and&#44; in contrast Yu et al&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">23</span></a> report a lower frequency&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Controversy still exists regarding patients with SLE about what factors are associated with renal graft loss&#44; and the most commonly described are&#58; being a younger recipient&#46; Not receiving induction therapy&#44; having immunosuppressant therapy with 2 drugs&#44; multiple blood transfusions&#44; a higher comorbidity index&#44; higher body weight&#44; donor or recipient of Afro-American race&#44; cadaveric donor&#44; time in dialysis&#44; a lower number of shared haplotypes&#44; tobacco consumption&#44; the presence of acute rejection&#44; lack of treatment adherence&#44; thrombosis of the artery or renal vein and delay in graft function&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">1&#44;3&#44;13&#44;17&#44;22&#44;24&#44;30&#44;31&#44;34</span></a> In contrast&#44; the use of mycophenolic acid&#44; tacrolimus and the absence of APA appear to be related to better survival of renal graft&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">22</span></a> The persistence of serological changes &#40;raised dsDNA and&#47;or hypocomplementemia&#41; during KT is not associated with graft loss&#46;<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">36</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">As with other aetiologies of ESKD&#44; the main cause of graft loss is chronic nephropathy of the graft &#40;8&#37;&#8211;35&#37;&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">8&#44;23&#44;37&#44;38</span></a> In our study&#44; a patient in treatment with cyclosporine after transplant presented with toxicity by cyclosporine&#44; a risk factor of chronic nephropathy of the graft&#44;<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">39</span></a> with an improvement in the kidney function after its suspension and no development of chronic nephropathy&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Similarly to that described&#44;<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">9&#44;15&#44;18&#44;32</span></a> no association was found between the loss of transplant and the time in dialysis&#46; In clinical practice&#44; the best transplant time is open to controversy&#46; In general&#44; most authors recommend starting dialysis of the transplant and waiting until the SLE is in complete from 6 to 12 months&#44;<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">9&#44;14&#44;23</span></a> especially between fast progression to ESKD to verify that no spontaneous recuperation of kidney function had occurred&#46;<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">40</span></a> In contrast&#44; other studies have demonstrated a better result in patients with less time in dialysis<a class="elsevierStyleCrossRefs" href="#bib0345"><span class="elsevierStyleSup">22&#44;29&#44;41</span></a> and without previous dialysis&#46;<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">4&#44;33&#44;39</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">Because thrombotic events usually result in graft loss&#44; from absence of collateral blood vessels&#44; the presence of APA is a concern due to the risk of thrombosis&#46; In some studies a higher risk of thrombosis has been described in SLE subjects&#44;<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">9&#44;15&#44;27&#44;28&#44;42&#44;43</span></a> while in others thrombosis as a cause of graft failure is reported as no different to the control groups&#46;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">3&#44;20&#44;44</span></a> In our study&#44; one patient with SLE with negative APA on 3 occasions and with no obstetric morbidity presented with thrombosis of the renal vein&#46; Diagnosis of APS cannot be ruled out totally for 2 reasons&#58; the possibility of presenting with antibodies aimed against phospholipids or cofactors could exist which are not assessed in clinical practice &#40;prothrombin&#44; phosphatidylethanolamine&#44; annexin <span class="elsevierStyleSmallCaps">v</span> or the vimentin&#47;cardiolipin complex&#41; which could cause the seronegative APS&#46;<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">45</span></a> The case has been described of 2 subjects who presented with repeated renal graft loss due to thrombotic complications with negative APA&#44; which were positive prior to the 3 transplant&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">22</span></a> APA may play a role in the early loss of the graft&#44; and it is therefore recommended that their repeated&#44; systematic detection be made during the pre-transplant period&#46;<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">4&#44;18&#44;22</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">The patient profile with SLE who has undergone KT differs from that of other ESRD causes&#44; and particularly because they are younger&#44; there is a predominance of women and there are fewer comorbidities&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">3</span></a> Despite the previously described controversies&#44; KT may be the best alternative of replacement for kidney function because it offers significantly better survival than peritoneal dialysis or haemodialysis&#44;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">3&#44;4&#44;46&#44;47</span></a> the prognosis at 10 years is comparable with other ESRD aetiologies&#44; it may offer better quality of life in comparison to dialysis&#44; and it is lower in cost in the long term&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">6</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">Our results may be interpreted with reserve due to their limitations&#44; which include&#58; a low number of cases&#44; the retrospective design of our analysis and that review of clinical records could not be obtained in all cases of risk factors described&#46; However&#44; we believe it is useful to have the description of the KT outcomes in our population&#44; since our results are consistent with those of previous studies&#46; Notwithstanding&#44; there is a need for future studies where systematic recording of the before-mentioned risk factors should be included to produce a prospective type analysis&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Ethical Considerations</span><p id="par0120" class="elsevierStylePara elsevierViewall">The study was conducted in accordance with the ethical guidelines of research in human beings&#46; It was approved by the local ethical and research committees in both hospital and is registered as&#58; R-2014-3501-4 and R-2011-3601-75&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Ethical Disclosures</span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Protection of human and animal subjects</span><p id="par0125" class="elsevierStylePara elsevierViewall">The authors declare that for this research no experimentation has been carried out on human beings or animals&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Confidentiality of data</span><p id="par0130" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Right to privacy and informed consent</span><p id="par0135" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conflict of Interest</span><p id="par0140" class="elsevierStylePara elsevierViewall">The authors declare they have not received any financing and there are no conflicts of interests&#46;</p></span></span>"
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          "titulo" => "Resumen"
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              "titulo" => "Introducci&#243;n"
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            0 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Characteristics of the Population Under Study"
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              "identificador" => "sec0030"
              "titulo" => "Kidney Graft Outcomes"
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              "titulo" => "Protection of human and animal subjects"
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              "titulo" => "Confidentiality of data"
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              "identificador" => "sec0060"
              "titulo" => "Right to privacy and informed consent"
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          "titulo" => "Conflict of Interest"
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    "pdfFichero" => "main.pdf"
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    "fechaRecibido" => "2017-03-25"
    "fechaAceptado" => "2017-07-06"
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          "clase" => "keyword"
          "titulo" => "Keywords"
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          "palabras" => array:3 [
            0 => "Systemic lupus erythematosus"
            1 => "Lupus nephritis"
            2 => "Kidney transplantation"
          ]
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          "clase" => "keyword"
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          "palabras" => array:3 [
            0 => "Lupus eritematoso sist&#233;mico"
            1 => "Nefropat&#237;a l&#250;pica"
            2 => "Trasplante renal"
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    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">End-stage renal disease &#40;ESRD&#41; due to lupus nephritis &#40;LN&#41; occurs in 10&#37;&#8211;30&#37; of patients&#46; Initially systemic lupus erythematosus &#40;SLE&#41; was a contraindication for kidney transplantation &#40;KT&#41;&#46; Today&#44; long-term graft survival remains controversial&#46; Our objective was to compare the survival after KT in patients with SLE or other causes of ESRD&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">All SLE patients who had undergone KT in a retrospective cohort were included&#46; Renal graft survival was compared with that of 50 controls&#44; matched for age&#44; sex&#44; and year of transplantation&#46; Survival was evaluated by the Kaplan&#8211;Meier test and the Cox proportional hazards model&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Twenty-five subjects with SLE were included&#46; The estimated 1-year&#44; 2- and 5-year survival rates for patients with SLE were 92&#37;&#44; 66&#37; and 66&#37;&#46; Renal graft survival did not differ between patients with SLE and other causes of ESRD &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;39&#41;&#46; The multivariate analysis showed no significant difference in graft survival between the two groups &#40;hazard ratio&#44; HR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;95&#44; 95&#37; confidence interval &#91;CI&#93; 0&#46;57&#8211;6&#46;61&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;28&#41;&#46; The recurrence rate of LN was 8&#37; and was not associated with graft loss&#46; Acute rejection was the only variable associated with graft loss in patients with SLE &#40;HR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>16&#46;5&#44; 95&#37; CI 1&#46;94&#8211;140&#46;1&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;01&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Renal graft survival in SLE patients did not differ from that reported for other causes of ESRD&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
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            "titulo" => "Results"
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            "titulo" => "Conclusions"
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La enfermedad renal terminal &#40;ERT&#41; por nefritis l&#250;pica &#40;NL&#41; se presenta en el 10-30&#37; de los pacientes&#46; Inicialmente&#44; el lupus eritematoso sist&#233;mico &#40;LES&#41; fue una contraindicaci&#243;n para el trasplante renal &#40;TR&#41;&#46; En la actualidad&#44; la supervivencia del injerto a largo plazo sigue siendo motivo de controversia&#46; El objetivo del estudio fue comparar la supervivencia del TR en los sujetos con LES con otras causas de ERT&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se incluy&#243; a todos los pacientes con TR en sujetos con LES&#44; de una cohorte retrospectiva en 2 centros de trasplante&#46; Se realiz&#243; un grupo de comparaci&#243;n con otras etiolog&#237;as de ERT en una relaci&#243;n 2&#58;1 emparejados por edad&#44; sexo y a&#241;o del trasplante&#46; La supervivencia se evalu&#243; por el m&#233;todo de Kaplan-Meier y por el modelo de riesgos proporcionales de Cox&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se incluy&#243; a 25 sujetos con LES&#46; La probabilidad de supervivencia en los sujetos con LES al a&#241;o&#44; 5 y 10 a&#241;os fue del 92&#44; el 66 y el 66&#37;&#44; respectivamente&#44; la cual no difiri&#243; del grupo de comparaci&#243;n &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;39&#41;&#46; En el an&#225;lisis multivariante no existi&#243; una diferencia significativa en la supervivencia del injerto entre los 2 grupos &#40;hazard ratio<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;95&#44; IC del 95&#37;&#44; 0&#44;57-6&#44;61&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;28&#41;&#46; La recurrencia de la NL fue del 8&#37; y no se relacion&#243; con la p&#233;rdida del injerto&#46; El rechazo agudo fue la &#250;nica variable asociada con la p&#233;rdida del injerto en los sujetos con LES &#40;HR 16&#44;5&#44; IC del 95&#37;&#44; 1&#44;94-140&#44;1&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El riesgo de p&#233;rdida del injerto renal en los sujetos con LES fue similar al de los sujetos con otras causas de ERT&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Horta-Baas G&#44; Camargo-Coronel A&#44; Miranda-Hern&#225;ndez DG&#44; G&#243;nzalez-Parra LG&#44; Romero-Figueroa MS&#44; P&#233;rez-Crist&#243;bal M&#46; Trasplante renal en lupus eritematoso sist&#233;mico&#58; comparaci&#243;n de la supervivencia del injerto con otras causas de enfermedad renal terminal&#46; Reumatol Clin&#46; 2019&#59;15&#58;140&#8211;145&#46;</p>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Kaplan&#8211;Meier survival graph comparing survival of the renal graft in subjects with SLE &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>25&#41; with other causes of kidney transplant &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>50&#41;&#46;</p>"
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          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">AZA&#58; azathioprine&#59; Pd&#58; peritoneal dialysis&#59; HD&#58; haemodialysis&#59; MMF&#58; mycophenolic acid&#59; PDN&#58; prednisone&#46;</p>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Systemic lupus erythematosus</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Comparison group</th><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span> value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Number of subjects</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Women &#40;n&#59; &#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Cause of kidney failure</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Class IV lupus GMN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Class V lupus GMN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Unknown lupus GMN &#40;without renal biopsy&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Idiopathic GMN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Systemic high blood pressure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Preeclampsia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Post streptococcal GMN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Vesicoureteral reflux&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Membranous GMN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Proliferate membranous GMN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Renal hypoplasia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Comorbidities</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>High blood pressure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Dyslipidaemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Right ventricular hypertrophy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hypothyroidism plus hyperparathyroidism&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Post transplant immunosuppressants</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>PDN<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>MMF<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>tacrolimus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>PDN<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>MMF<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>cyclosporine A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>PDN<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>AZA<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>cyclosporine A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>PDN<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>an immunosuppressant&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Other combinations&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Pre-transplant deep vein thrombosis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Kidney replacement therapy</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No prior dialysis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>HD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>PD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>PD<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>HD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Type of graft</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Living donor relative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cadaveric donor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Living non-relative donor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Acute rejection</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;534&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Chronic nephropathy of the graft</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;786&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Thrombosis in post transplant</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Demographic Traits of Patients With Kidney Transplant Due to Lupic Nephritis and Other Causes of Terminal Kidney Disease&#46;</p>"
        ]
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          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">a</span> One patient presents with chronic nephropathy of the graft plus infection by the BK virus&#46;</p><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">b</span> The same patient presented with acute rejection in addition to renal vein thrombosis&#46;</p>"
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                  <table border="0" frame="\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Chronic nephropathy<span class="elsevierStyleSup">a</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Acute rejection&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Death&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Renal vein thrombosis<span class="elsevierStyleSup">b</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Non adherence to treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Causes Associated With the Loss of the Renal Graft in the Lupus Nephritis Group and Other Causes of Terminal Renal Disease&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:47 [
            0 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lupus nephritis and end-stage kidney disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "N&#46; Maroz"
                            1 => "M&#46;S&#46; Segal"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/MAJ.0b013e31827f4ee3"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Med Sci"
                        "fecha" => "2013"
                        "volumen" => "346"
                        "paginaInicial" => "319"
                        "paginaFinal" => "323"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23370533"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Trends in the incidence&#44; demographics&#44; and outcomes of end-stage renal disease due to lupus nephritis in the US from 1995 to 2006"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46;H&#46; Costenbader"
                            1 => "A&#46; Desai"
                            2 => "G&#46;S&#46; Alarcon"
                            3 => "L&#46;T&#46; Hiraki"
                            4 => "T&#46; Shaykevich"
                            5 => "M&#46;A&#46; Brookhart"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/art.30293"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arthritis Rheum"
                        "fecha" => "2011"
                        "volumen" => "63"
                        "paginaInicial" => "1681"
                        "paginaFinal" => "1688"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21445962"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Long-term outcomes of end-stage kidney disease for patients with lupus nephritis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46; Zhang"
                            1 => "G&#46; Lee"
                            2 => "X&#46; Liu"
                            3 => "E&#46;M&#46; Pascoe"
                            4 => "S&#46;V&#46; Badve"
                            5 => "N&#46;C&#46; Boudville"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.kint.2016.02.014"
                      "Revista" => array:6 [
                        "tituloSerie" => "Kidney Int"
                        "fecha" => "2016"
                        "volumen" => "89"
                        "paginaInicial" => "1337"
                        "paginaFinal" => "1345"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27165824"
                            "web" => "Medline"
                          ]
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                      ]
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            ]
            3 => array:3 [
              "identificador" => "bib0255"
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