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2-year clinical outcomes after implantation of sirolimus-eluting, paclitaxel-eluting, and bare-metal coronary stents: results from the WDHR (Western Denmark Heart Registry).

https://arctichealth.org/en/permalink/ahliterature89935
Source
J Am Coll Cardiol. 2009 Feb 24;53(8):658-64
Publication Type
Article
Date
Feb-24-2009
Author
Kaltoft Anne
Jensen Lisette Okkels
Maeng Michael
Tilsted Hans Henrik
Thayssen Per
Bøttcher Morten
Lassen Jens Flensted
Krusell Lars Romer
Rasmussen Klaus
Hansen Knud Nørregaard
Pedersen Lars
Johnsen Søren Paaske
Sørensen Henrik Toft
Thuesen Leif
Author Affiliation
Department of Cardiology, Aarhus University Hospital, Skejby, Brendstrupgaardsvej 100, 8200 Aarhus N, Denmark. annekaltoft@stofanet.dk
Source
J Am Coll Cardiol. 2009 Feb 24;53(8):658-64
Date
Feb-24-2009
Language
English
Publication Type
Article
Keywords
Aged
Angioplasty, Transluminal, Percutaneous Coronary
Coronary Disease - mortality - therapy
Drug-Eluting Stents - adverse effects
Female
Humans
Immunosuppressive Agents
Male
Middle Aged
Myocardial Infarction - etiology
Paclitaxel
Sirolimus
Stents - adverse effects
Thrombosis - etiology
Abstract
OBJECTIVES: This registry study assessed the safety and efficacy of the 2 types of drug-eluting stents (DES), sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES), compared with bare-metal stents (BMS). BACKGROUND: Drug-eluting stents may increase the risk of stent thrombosis (ST), myocardial infarction (MI), and death. METHODS: A total of 12,395 consecutive patients with coronary intervention and stent implantation recorded in the Western Denmark Heart Registry from January 2002 through June 2005 were followed up for 2 years. Data on death and MI were ascertained from national medical databases. We used Cox regression analysis to control for confounding. RESULTS: The 2-year incidence of definite ST was 0.64% in BMS patients, 0.79% in DES patients (adjusted relative risk [RR]: 1.09; 95% confidence interval [CI]: 0.72 to 1.65), 0.50% in SES patients (adjusted RR: 0.63, 95% CI: 0.35 to 1.15), and 1.30% in PES patients (adjusted RR: 1.82, 95% CI: 1.13 to 2.94). The incidence of MI was 3.8% in BMS-treated patients, 4.5% in DES-treated patients (adjusted RR: 1.24, 95% CI: 1.02 to 1.51), 4.1% in SES-treated patients (adjusted RR: 1.15, 95% CI: 0.91 to 1.47), and 5.3% in PES-treated patients (adjusted RR: 1.38, 95% CI: 1.06 to 1.81). Whereas overall 2-year adjusted mortality was similar in the BMS and the 2 DES stent groups, 12- to 24-month mortality was higher in patients treated with PES (RR 1.46, 95% CI: 1.02 to 2.09). Target lesion revascularization was reduced in both DES groups. CONCLUSIONS: During 2 years of follow-up, patients treated with PES had an increased risk of ST and MI compared with those treated with BMS and SES. Mortality after 12 months was also increased in PES patients.
Notes
Comment In: J Am Coll Cardiol. 2009 Feb 24;53(8):665-619232898
PubMed ID
19232897 View in PubMed
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2-year patient-related versus stent-related outcomes: the SORT OUT IV (Scandinavian Organization for Randomized Trials With Clinical Outcome IV) Trial.

https://arctichealth.org/en/permalink/ahliterature120892
Source
J Am Coll Cardiol. 2012 Sep 25;60(13):1140-7
Publication Type
Article
Date
Sep-25-2012
Author
Lisette Okkels Jensen
Per Thayssen
Evald Høj Christiansen
Hans Henrik Tilsted
Michael Maeng
Knud Nørregaard Hansen
Anne Kaltoft
Henrik Steen Hansen
Hans Erik Bøtker
Lars Romer Krusell
Jan Ravkilde
Morten Madsen
Leif Thuesen
Jens Flensted Lassen
Author Affiliation
Department of Cardiology, Odense University Hospital, Odense, Denmark. okkels@dadlnet.dk
Source
J Am Coll Cardiol. 2012 Sep 25;60(13):1140-7
Date
Sep-25-2012
Language
English
Publication Type
Article
Keywords
Aged
Angioplasty, Balloon, Coronary
Coronary Artery Disease - mortality - therapy
Death
Denmark
Drug-Eluting Stents
Female
Follow-Up Studies
Humans
Immunosuppressive Agents - therapeutic use
Male
Middle Aged
Myocardial Infarction - etiology
Myocardial Revascularization - statistics & numerical data
Single-Blind Method
Sirolimus - adverse effects - analogs & derivatives - therapeutic use
Thrombosis - etiology
Treatment Outcome
Abstract
There are limited head-to-head randomized data on patient-related versus stent-related outcomes for everolimus-eluting stents (EES) and sirolimus-eluting stents (SES).
In the SORT OUT IV (Scandinavian Organization for Randomized Trials With Clinical Outcome IV) trial, comparing the EES with the SES in patients with coronary artery disease, the EES was noninferior to the SES at 9 months.
The primary endpoint was a composite: cardiac death, myocardial infarction (MI), definite stent thrombosis, or target vessel revascularization. Safety and efficacy outcomes at 2 years were further assessed with specific focus on patient-related composite (all death, all MI, or any revascularization) and stent-related composite outcomes (cardiac death, target vessel MI, or symptom-driven target lesion revascularization). A total of 1,390 patients were assigned to receive the EES, and 1,384 patients were assigned to receive the SES.
At 2 years, the composite primary endpoint occurred in 8.3% in the EES group and in 8.7% in the SES group (hazard ratio [HR]: 0.94, 95% confidence interval [CI]: 0.73 to 1.22). The patient-related outcome: 15.0% in the EES group versus 15.6% in the SES group, (HR: 0.95, 95% CI: 0.78 to 1.15), and the stent-related outcome: 5.2% in the EES group versus 5.3% in the SES group (HR: 0.97, 95% CI: 0.70 to 1.35) did not differ between groups. Rate of definite stent thrombosis was lower in the EES group (0.2% vs. 0.9%, (HR: 0.23, 95% CI: 0.07 to 0.80).
At 2-year follow-up, the EES was found to be noninferior to the SES with regard to both patient-related and stent-related clinical outcomes.
PubMed ID
22958957 View in PubMed
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6-Thioguanine therapy in Crohn's disease--observational data in Swedish patients.

https://arctichealth.org/en/permalink/ahliterature91993
Source
Dig Liver Dis. 2009 Mar;41(3):194-200
Publication Type
Article
Date
Mar-2009
Author
Almer S H C
Hjortswang H.
Hindorf U.
Author Affiliation
Department of Clinical and Experimental Medicine, Division of Gastroenterology and Hepatology, Faculty of Health Sciences, Linköping University, Linköping, Sweden. sven.almer@lio.se
Source
Dig Liver Dis. 2009 Mar;41(3):194-200
Date
Mar-2009
Language
English
Publication Type
Article
Keywords
6-Mercaptopurine - adverse effects
Adult
Aged
Antimetabolites, Antineoplastic - therapeutic use
Azathioprine - adverse effects
Crohn Disease - drug therapy
Drug resistance
Female
Humans
Immunosuppressive Agents - adverse effects
Male
Middle Aged
Prospective Studies
Remission Induction
Severity of Illness Index
Sweden
Thioguanine - therapeutic use
Young Adult
Abstract
BACKGROUND AND AIMS: Adverse events (AE) leading to discontinuation or dose-reduction of thiopurine therapy (TP) occur in 9-28% of patients with inflammatory bowel disease. 6-Thioguanine (6-TG) has been proposed as an alternative treatment in patients intolerant for azathioprine (AZA), but some concerns have been raised about drug safety. METHODS: We evaluated in a prospective manner the tolerance and efficacy of 6-TG in 23 Crohn's disease (CD) patients (13 men, median age 41 (19-65) years) with prior intolerance (n=18) or resistance (n=5) to AZA and/or 6-mercaptopurine (6-MP). In addition, eight patients had tried mycophenolate mofetil. Seventeen patients (74%) had undergone intestinal resection, often several times. RESULTS: Patients were treated with a median daily dose of 40 mg 6-TG (range 20-60) for 259 (15-2272) days. Seven of 13 patients (54%) with active disease went into remission after 8 (4-26) weeks. Sixteen patients (70%) experienced AE that lead to discontinuation (n=10) after 85 (15-451) days or dose reduction (n=6) after 78 (10-853) days. Ten of 18 patients (56%) with prior TP-intolerance discontinued 6-TG treatment due to AE compared to none of five patients with TP-resistance (p=0.046). Of 13 patients that tolerated 6-TG, eight discontinued the drug due to therapeutic failure (n=5) or safety concerns (n=3). Eight patients (35%) continued treatment beyond 12 months. There was no significant difference in maximum thioguanine nucleotide levels between patients with AE leading to discontinuation/dose reduction and patients without AE, 652 (99-2488) vs. 551 (392-1574) pmol/8 x 10(8) RBC; p=0.80. CONCLUSIONS: In this cohort of CD patients with severe disease failing traditional thiopurine treatment, a small fraction (22%) had long-term benefit of 6-TG-treatment. 6-TG therapy seems to offer a limited therapeutic gain for patients intolerant to both AZA and 6-MP and other treatment options should be considered.
PubMed ID
18799369 View in PubMed
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99th Dahlem conference on infection, inflammation and chronic inflammatory disorders: immune therapies of type 1 diabetes: new opportunities based on the hygiene hypothesis.

https://arctichealth.org/en/permalink/ahliterature144028
Source
Clin Exp Immunol. 2010 Apr;160(1):106-12
Publication Type
Article
Date
Apr-2010
Author
L. Chatenoud
S. You
H. Okada
C. Kuhn
B. Michaud
J-F Bach
Author Affiliation
Université Paris Descarte, Paris, France. lucienne.chatenoud@inserm.fr
Source
Clin Exp Immunol. 2010 Apr;160(1):106-12
Date
Apr-2010
Language
English
Publication Type
Article
Keywords
Adolescent
Animals
Autoantigens - immunology
Bacteria - immunology
Canada - epidemiology
Child
Diabetes Mellitus, Type 1 - immunology - therapy
Europe - epidemiology
Humans
Hygiene
Hypersensitivity - immunology
Immunosuppression - methods
Immunotherapy - methods
Infection - immunology - microbiology
Mice
Pancreatitis - immunology - microbiology
Toll-Like Receptors - agonists
Young Adult
Abstract
Insulin-dependent (type 1) diabetes is a prototypic organ-specific autoimmune disease resulting from the selective destruction of insulin-secreting beta cells within pancreatic islets of Langerhans by an immune-mediated inflammation involving autoreactive CD4(+) and CD8(+) T lymphocytes which infiltrate pancreatic islets. Current treatment is substitutive, i.e. chronic use of exogenous insulin which, in spite of significant advances, is still associated with major constraints (multiple daily injections, risks of hypoglycaemia) and lack of effectiveness over the long term in preventing severe degenerative complications. Finding a cure for autoimmune diabetes by establishing effective immune-based therapies is a real medical health challenge, as the disease incidence increases steadily in industrialized countries. As the disease affects mainly children and young adults, any candidate immune therapy must therefore be safe and avoid a sustained depression of immune responses with the attendant problems of recurrent infection and drug toxicity. Thus, inducing or restoring immune tolerance to target autoantigens, controlling the pathogenic response while preserving the host reactivity to exogenous/unrelated antigens, appears to be the ideal approach. Our objective is to review the major progress accomplished over the last 20 years towards that aim. In addition, we would like to present another interesting possibility to access new preventive strategies based on the 'hygiene hypothesis', which proposes a causal link between the increasing incidence of autoimmune diseases, including diabetes, and the decrease of the infectious burden. The underlying rationale is to identify microbial-derived compounds mediating the protective activity of infections which could be developed therapeutically.
Notes
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PubMed ID
20415859 View in PubMed
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The 1994 annual report of the North American Pediatric Renal Transplant Cooperative Study.

https://arctichealth.org/en/permalink/ahliterature211369
Source
Pediatr Nephrol. 1996 Aug;10(4):422-34
Publication Type
Article
Date
Aug-1996
Author
E C Kohaut
A. Tejani
Author Affiliation
University of Alabama, Birmingham, USA.
Source
Pediatr Nephrol. 1996 Aug;10(4):422-34
Date
Aug-1996
Language
English
Publication Type
Article
Keywords
Adolescent
Annual Reports as Topic
Canada - epidemiology
Child
Child, Preschool
Female
Graft Rejection - prevention & control
Humans
Immunosuppressive Agents - therapeutic use
Infant
Kidney Failure, Chronic - mortality - surgery
Kidney Transplantation - utilization
Male
Renal Dialysis
United States - epidemiology
Abstract
The North American Pediatric Renal Transplant Cooperative Study (NAPRTCS) is a research effort that was organized and initiated in 1987. The following manuscript is the 1994 NAPRTCS annual report which has summarized data that has been voluntarily contributed by 83 centers. The report includes data on 3,183 patients who have undergone a total of 3,445 renal transplants between 1 January 1987 and 18 February 1994 when the data set was closed. The report also contains data on 1,611 independent courses of dialysis which were initiated between 1 January 1992 and 18 February 1994. This report is meant to update the previous NAPRTCS annual reports as well as demonstrate how the NAPRTCS database has changed clinical practice since its inception. There have been 855 graft failures among the 3,438 transplants. Due to the maturing of the database, chronic rejection now accounts for 34% of graft failures which have occurred over the last year. Graft failure was increased in recipients if the recipients were 6 years did not have catch-up growth post transplant. Overall graft survival has improved markedly since the inception of this study. The dialysis database is just maturing and the data confirm that growth on dialysis continues to be very poor. The 1994 annual report of NAPRTCS extends previous findings of this valuable database. It is gratifying to know that early findings of NAPRTCS have led to changes in therapy which have led to improvement in the care of these very special children.
PubMed ID
8865236 View in PubMed
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ABO-incompatible kidney transplantation.

https://arctichealth.org/en/permalink/ahliterature139624
Source
Dan Med Bull. 2010 Oct;57(10):A4197
Publication Type
Article
Date
Oct-2010
Author
Karoline Schousboe
Kjell Titlestad
Francois Baudier
Lars Ulrich Hansen
Claus Bistrup
Author Affiliation
Department of Nephrology, Odense University Hospital, Denmark. kschousboe@dadlnet.dk
Source
Dan Med Bull. 2010 Oct;57(10):A4197
Date
Oct-2010
Language
English
Publication Type
Article
Keywords
ABO Blood-Group System
Adult
Aged, 80 and over
Antibodies, Monoclonal, Murine-Derived - therapeutic use
Antigens, CD20 - immunology
Blood Group Incompatibility - blood - immunology
Creatinine - blood
Denmark
Female
Graft Rejection
Humans
Immunologic Factors - therapeutic use
Immunosuppressive Agents - therapeutic use
Kidney Failure, Chronic - blood - mortality - surgery
Kidney Transplantation - methods
Male
Middle Aged
Mycophenolic Acid - analogs & derivatives - therapeutic use
Retrospective Studies
Tacrolimus - therapeutic use
Abstract
Kidney transplantation is the optimal treatment for many patients with end-stage renal disease (ESRD). Due to shortage of donor kidneys in Denmark, there is a need to expand the possibilities for donation. At the Odense University Hospital (OUH), we have introduced ABO-incompatible kidney transplantation. We used antigenspecific immunoadsorptions to remove blood group antibodies and anti-CD20 antibody (rituximab) to inhibit the antibody production. The aim of introducing the ABO-incompatible kidney transplantation at the OUH was to increase the rate of living donor kidney transplantation without increasing rejection or mortality rates.
Retrospective evaluation. Eleven patients received ABO-incompatible kidney transplantation. The patients were followed for 3-26 months.
One patient had an antibody-mediated rejection, one patient suffered T-cell-mediated rejection, and one patient died of myocardial infarction with a functioning graft on the third post-operative day. Both rejections were treated effectively. Among the patients, the average serum creatinine level was 128 micromol/l.
The rejection and mortality rates for ABO-incompatible kidney transplantation at the OUH are similar to the results from ABO-compatible kidney transplantations performed at the OUH and at other hospitals.
PubMed ID
21040684 View in PubMed
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ABO-incompatible liver transplantation for critically ill adult patients.

https://arctichealth.org/en/permalink/ahliterature163388
Source
Transpl Int. 2007 Aug;20(8):675-81
Publication Type
Article
Date
Aug-2007
Author
Christian Toso
Mohammed Al-Qahtani
Faisal A Alsaif
David L Bigam
Glenda A Meeberg
A M James Shapiro
Vincent G Bain
Norman M Kneteman
Author Affiliation
Department of Surgery, Section of Hepatobiliary, Pancreatic and Transplant Surgery, University of Alberta, Edmonton, Canada.
Source
Transpl Int. 2007 Aug;20(8):675-81
Date
Aug-2007
Language
English
Publication Type
Article
Keywords
ABO Blood-Group System - immunology
Adolescent
Adult
Aged
Alberta - epidemiology
Critical Illness
Female
Follow-Up Studies
Graft Rejection - blood - epidemiology - prevention & control
Graft Survival
Humans
Immunosuppressive Agents - therapeutic use
Incidence
Liver Failure - blood - surgery
Liver Transplantation - adverse effects
Male
Middle Aged
Prognosis
Retrospective Studies
Survival Rate
Abstract
ABO incompatible (ABO-In) liver transplant remains a controversial solution to acute liver failure in adults. Adult liver recipients with acute liver failure or severely decompensated end-stage disease, intubated and/or in the intensive care unit, were grouped as ABO-In (n = 14), ABO-compatible (n = 29, ABO-C) and ABO-identical (n = 65, ABO-Id). ABO-In received quadruple immunosuppression with antibody-depleting induction agents (except two), calcineurin inhibitors, antimetabolites and steroids. No significant difference of patient and graft survivals was observed among ABO-In, ABO-C and ABO-Id: graft survivals were 64%, 62% and 67%, respectively, in 1 year and 56%, 54% and 60%, respectively, in 5 years; patient survivals 86%, 69% and 67%, respectively, in 1 year and 77%, 61% and 62%, respectively, in 5 years. Three ABO-In grafts were lost (one hyper-acute rejection and two hepatic artery thrombosis). Surgical and infectious complications were similarly distributed between groups, except the hepatic artery thrombosis, more frequent in ABO-In (2, 14%) than ABO-I (1, 1.5%, P
PubMed ID
17521384 View in PubMed
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Active cytomegalovirus infection diagnosed by real-time PCR in patients with inflammatory bowel disease: a prospective, controlled observational study (.).

https://arctichealth.org/en/permalink/ahliterature285270
Source
Scand J Gastroenterol. 2016 Sep;51(9):1075-80
Publication Type
Article
Date
Sep-2016
Author
Mari Thörn
Fredrik Rorsman
Anders Rönnblom
Per Sangfelt
Alkwin Wanders
Britt-Marie Eriksson
Kåre Bondeson
Source
Scand J Gastroenterol. 2016 Sep;51(9):1075-80
Date
Sep-2016
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Case-Control Studies
Cytomegalovirus
Cytomegalovirus Infections - diagnosis
DNA, Viral - analysis
Feces - virology
Female
Humans
Immunohistochemistry
Immunosuppression - adverse effects
Inflammatory Bowel Diseases - complications - drug therapy
Male
Middle Aged
Prospective Studies
Real-Time Polymerase Chain Reaction
Risk factors
Severity of Illness Index
Sweden
Young Adult
Abstract
It is assumed that cytomegaloviral (CMV) infection in inflammatory bowel disease (IBD) is caused by reactivation due to the immunosuppressive therapy, but the role of CMV as a pathophysiological factor and prognostic marker in IBD is unclear. The aim of this study was to investigate CMV infection in IBD, with real-time polymerase chain reaction (PCR) and immunohistochemistry, with emphasis on newly diagnosed disease.
In this prospective, controlled study, 67 patients with IBD and 34 control patients with irritable bowel syndrome (IBS) or rectal bleeding were included. Serology for CMV was analysed along with CMV DNA in plasma, mucosal biopsies, and faeces. Mucosal biopsies were further analysed with histopathology and CMV immunohistochemistry.
Detection of CMV IgM was more common in patients with IBD, compared to controls, 21% versus 3%. CMV DNA was found in 16% of patients with newly diagnosed, untreated IBD and in 38% of steroid-treated patients. Four of the five patients that needed urgent surgery were CMV-DNA positive in at least one of three sample types. None of the controls had detectable CMV DNA.
Active CMV infection was found in high proportions of newly diagnosed untreated patients with IBD, in patients on immunosuppression and in patients in the need of surgery. Low CMV-DNA levels in non-immunosuppressed patients were not a risk factor for the development of more severe IBD, while the detection of CMV DNA in patients on immunosuppressive therapy may foresee disease progression.
PubMed ID
27142339 View in PubMed
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Adherence of Renal Transplant Recipients to Once-daily, Prolonged-Release and Twice-daily, Immediate-release Tacrolimus-based Regimens in a Real-life Setting in Sweden.

https://arctichealth.org/en/permalink/ahliterature298202
Source
Transplant Proc. 2018 Dec; 50(10):3275-3282
Publication Type
Journal Article
Date
Dec-2018
Author
B Fellström
J Holmdahl
N Sundvall
E Cockburn
S Kilany
L Wennberg
Author Affiliation
Department of Medical Sciences, Uppsala University, Uppsala, Sweden. Electronic address: bengt.fellstrom@medsci.uu.se.
Source
Transplant Proc. 2018 Dec; 50(10):3275-3282
Date
Dec-2018
Language
English
Publication Type
Journal Article
Keywords
Adult
Aged
Delayed-Action Preparations
Drug Administration Schedule
Female
Graft Rejection - prevention & control
Humans
Immunosuppressive Agents - administration & dosage
Kidney Transplantation
Male
Medication Adherence
Middle Aged
Sweden
Tacrolimus - administration & dosage
Transplant Recipients
Abstract
In this study we investigated medication adherence of kidney transplant patients (KTPs) to an immediate-release tacrolimus (IR-T) regimen and, after conversion, to a prolonged-release tacrolimus (PR-T) regimen in routine clinical practice.
This was a non-interventional, observational, multicenter Swedish study. We included adult KTPs with stable graft function, remaining on IR-T or converting from IR-T to PR-T. Data were collected at baseline, and months 3, 6, and 12 post-baseline. The primary endpoint was adherence using the Basel Assessment of Adherence to Immunosuppressive Medication Scale (BAASIS©). Secondary assessments included tacrolimus dose and trough levels, clinical laboratory parameters (eg, estimated glomerular filtration rate), and adverse drug reactions (ADRs).
Overall, data from 233 KTPs were analyzed (PR-T, n = 175; IR-T, n = 58). Mean change in PR-T dose from baseline (4.8 mg/d) to month 12 was -0.2 mg/d, and for IR-T (4.2 mg/d) was -0.4 mg/d; tacrolimus trough levels remained similar. Overall adherence was similar between baseline and month 12 in both groups (PR-T: 54.4% vs 57.0%, respectively; IR-T: 65.5% vs 69.4%); timing adherence followed a similar pattern. The probability of taking adherence improved between baseline and month 12 (odds ratio, 1.97; P = .0092) in the PR-T group only. Mean BAASIS visual analog scale score at baseline was 94.3 ± 11.1% (PR-T) and 95.3 ± 7.6% (IR-T), and >95% at subsequent visits. Laboratory parameters remained stable. Eight (4.6%) patients receiving PR-T (none receiving IR-T) had ADRs considered probably/possibly treatment-related.
Disparity existed between high, patient-perceived and low, actual adherence. Overall adherence to the immunosuppressive regimen (measured by BAASIS) did not improve significantly over 12 months in stable KTPs converting to PR-T or remaining on IR-T; renal function remained stable.
PubMed ID
30577197 View in PubMed
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529 records – page 1 of 53.