{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T10:31:04Z","timestamp":1765881064042,"version":"3.48.0"},"reference-count":76,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2020,1,7]],"date-time":"2020-01-07T00:00:00Z","timestamp":1578355200000},"content-version":"unspecified","delay-in-days":6,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010665","name":"H2020 Marie Sk\u0142odowska-Curie Actions","doi-asserted-by":"publisher","award":["713660"],"award-info":[{"award-number":["713660"]}],"id":[{"id":"10.13039\/100010665","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2019,12,5]]},"published-print":{"date-parts":[[2020,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Infections remain a threat for solid organ and stem cell transplant recipients. Antimicrobial prophylaxis and pre-emptive therapy have improved survival of these patients; however, the failure rates of prophylaxis are not negligible. The aim of this systematic review is to explore the reasons behind failure of antimicrobial prophylaxis and pre-emptive therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>This systematic review included prospective randomised controlled trials and prospective single-arm studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>The studies included were on prophylaxis and pre-emptive therapy of opportunistic infections in transplant recipients. Studies were included from databases MEDLINE, CENTRAL and Embase published until October first 2018.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>Primary outcome measures were breakthrough infections, adverse events leading to stopping of treatment, switching medication or dose reduction. Secondary outcome measures were acquired resistance to antimicrobials, antifungals or antivirals and death.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>From 3317 identified records, 30 records from 24 studies with 2851 patients were included in the systematic review. Seventeen focused on prophylactic and pre-emptive treatment of cytomegalovirus and seven studies on invasive fungal infection. The main reasons for failure of prophylaxis and pre-emptive therapy were adverse events and breakthrough infections, which were described in 54% (13 studies) and 38% (9 studies) of the included studies, respectively. In 25%, six of the studies, a detailed description of patients who experienced failure of prophylaxis or pre-emptive therapy was unclear or lacking.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our results show that although failure is reported in the studies, the level of detail prohibits a detailed analysis of failure of prophylaxis and pre-emptive therapy. Clearly reporting on patients with a negative outcome should be improved. We have provided guidance on how to detect failure early in a clinical setting in accordance to the results from this systematic review.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PROSPERO registration number<\/jats:title>\n                    <jats:p>CRD42017077606.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2019-034940","type":"journal-article","created":{"date-parts":[[2020,1,8]],"date-time":"2020-01-08T03:55:56Z","timestamp":1578455756000},"page":"e034940","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Exploring failure of antimicrobial prophylaxis and pre-emptive therapy for transplant recipients: a systematic review"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6478-1959","authenticated-orcid":false,"given":"Anne-Grete","family":"M\u00e4rtson","sequence":"first","affiliation":[{"name":"Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martijn","family":"Bakker","sequence":"additional","affiliation":[{"name":"Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hans","family":"Blokzijl","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erik A M","family":"Verschuuren","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Diseases and Tuberculosis, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefan P","family":"Berger","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lambert F R","family":"Span","sequence":"additional","affiliation":[{"name":"Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tjip S","family":"van der Werf","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Diseases and Tuberculosis, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands"},{"name":"Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6703-0288","authenticated-orcid":false,"given":"Jan-Willem C","family":"Alffenaar","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands"},{"name":"The University of Sydney, Sydney Pharmacy School, Sydney, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,1,7]]},"reference":[{"key":"2025121602285056000_10.1.e034940.1","doi-asserted-by":"publisher","DOI":"10.1007\/s00277-016-2711-1"},{"key":"2025121602285056000_10.1.e034940.2","doi-asserted-by":"crossref","first-page":"e15","DOI":"10.1016\/j.ajic.2010.06.009","article-title":"The economic costs to United States hospitals of invasive fungal infections in transplant patients","volume":"39","author":"Menzin","year":"2011","journal-title":"Am J Infect Control"},{"key":"2025121602285056000_10.1.e034940.3","doi-asserted-by":"crossref","unstructured":"Hakimi Z , Aball\u00e9a S , Ferchichi S , et al . Burden of cytomegalovirus disease in solid organ transplant recipients: a national matched cohort study in an inpatient setting. Transpl Infect Dis 2017;19.doi:10.1111\/tid.12732","DOI":"10.1111\/tid.12732"},{"key":"2025121602285056000_10.1.e034940.4","doi-asserted-by":"crossref","first-page":"293","DOI":"10.3390\/jof1030293","article-title":"Pneumocystis pneumonia in solid-organ transplant recipients","volume":"1","author":"Iriart","year":"2015","journal-title":"JoF"},{"key":"2025121602285056000_10.1.e034940.5","doi-asserted-by":"crossref","unstructured":"Taplitz RA , Kennedy EB , Bow EJ , et al . Antimicrobial prophylaxis for adult patients with cancer-related immunosuppression: ASCO and IDSA clinical practice guideline update. J Clin Oncol September 2018.","DOI":"10.1200\/JOP.18.00366"},{"key":"2025121602285056000_10.1.e034940.6","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/j.ccc.2018.08.010","article-title":"Infections in heart and lung transplant recipients","volume":"35","author":"Alsaeed","year":"2019","journal-title":"Crit Care Clin"},{"key":"2025121602285056000_10.1.e034940.7","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2009.02824.x"},{"key":"2025121602285056000_10.1.e034940.8","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra064928"},{"key":"2025121602285056000_10.1.e034940.9","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.12388"},{"key":"2025121602285056000_10.1.e034940.10","doi-asserted-by":"crossref","unstructured":"Navarro D , San-Juan R , Manuel O , et al . Cytomegalovirus infection management in solid organ transplant recipients across European centers in the time of molecular diagnostics: an ESGICH survey. Transpl Infect Dis 2017;19.doi:10.1111\/tid.12773","DOI":"10.1111\/tid.12773"},{"key":"2025121602285056000_10.1.e034940.11","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciw326"},{"key":"2025121602285056000_10.1.e034940.12","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000002191"},{"key":"2025121602285056000_10.1.e034940.13","doi-asserted-by":"crossref","unstructured":"Gafter-Gvili A , Fraser A , Paul M , et al . Antibiotic prophylaxis for bacterial infections in afebrile neutropenic patients following chemotherapy. Cochrane database Syst Rev 2012;27.doi:10.1002\/14651858.CD004386.pub3","DOI":"10.1002\/14651858.CD004386.pub3"},{"key":"2025121602285056000_10.1.e034940.14","doi-asserted-by":"crossref","unstructured":"Stern A , Green H , Paul M , et al . Prophylaxis for Pneumocystis pneumonia (PCP) in non-HIV immunocompromised patients. Cochrane Database Syst Rev 2014;26.doi:10.1002\/14651858.CD005590.pub3","DOI":"10.1002\/14651858.CD005590.pub3"},{"key":"2025121602285056000_10.1.e034940.15","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2010.03074.x"},{"key":"2025121602285056000_10.1.e034940.16","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1097\/TP.0000000000002029","article-title":"Comparison of preemptive therapy and antiviral prophylaxis for prevention of cytomegalovirus in seropositive liver transplant recipients","volume":"102","author":"Liu","year":"2018","journal-title":"Transplantation"},{"key":"2025121602285056000_10.1.e034940.17","first-page":"2758","article-title":"Randomized, double-blind trial of anidulafungin versus fluconazole for prophylaxis of invasive fungal infections in high-risk liver transplant recipients","volume":"14","author":"Winston","year":"2014","journal-title":"Am J"},{"key":"2025121602285056000_10.1.e034940.18","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0b013e3181bc0301"},{"key":"2025121602285056000_10.1.e034940.19","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbmt.2012.03.014"},{"key":"2025121602285056000_10.1.e034940.20","doi-asserted-by":"crossref","DOI":"10.1111\/tid.12691","article-title":"A retrospective study to describe the epidemiology and outcomes of opportunistic infections after abdominal organ transplantation","volume":"19","author":"Helfrich","year":"2017","journal-title":"Transpl Infect Dis"},{"key":"2025121602285056000_10.1.e034940.21","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-151-4-200908180-00136"},{"key":"2025121602285056000_10.1.e034940.22","unstructured":"Higgins JPT , Sterne JAC , Savovi\u0107 J , et al . A revised tool for assessing risk of bias in randomized trials in: Chandler J, McKenzie J, Boutron I, Welch V (editors). Cochrane methods. Cochrane Database Syst Rev 2016;10."},{"key":"2025121602285056000_10.1.e034940.23","doi-asserted-by":"crossref","unstructured":"Sterne JAC , Hern\u00e1n MA , Reeves BC , et al . ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 2016;355.doi:10.1136\/bmj.i4919","DOI":"10.1136\/bmj.i4919"},{"key":"2025121602285056000_10.1.e034940.24","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0b013e3181ff1493"},{"key":"2025121602285056000_10.1.e034940.25","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.02130-15"},{"key":"2025121602285056000_10.1.e034940.26","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2011.02.017"},{"key":"2025121602285056000_10.1.e034940.27","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-152-12-201006150-00003"},{"key":"2025121602285056000_10.1.e034940.28","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1111\/j.1399-3062.2011.00689.x","article-title":"Oral valganciclovir versus ganciclovir as delayed pre-emptive therapy for patients after allogeneic hematopoietic stem cell transplant: a pilot trial (04-0274) and review of the literature","volume":"14","author":"Chawla","year":"2012","journal-title":"Transpl Infect Dis"},{"key":"2025121602285056000_10.1.e034940.29","doi-asserted-by":"publisher","DOI":"10.7326\/M13-2729"},{"key":"2025121602285056000_10.1.e034940.30","doi-asserted-by":"publisher","DOI":"10.1007\/s12185-010-0580-2"},{"key":"2025121602285056000_10.1.e034940.31","first-page":"526","article-title":"Efficacy and safety of low-dose versus standard-dose valganciclovir for prevention of cytomegalovirus disease in intermediate-risk kidney transplant recipients","volume":"14","author":"Halim","year":"2016","journal-title":"Exp Clin Transplant"},{"key":"2025121602285056000_10.1.e034940.32","first-page":"156","article-title":"Successful cost-effective prevention of cytomegalovirus disease in kidney transplant recipients using low-dose valganciclovir","volume":"15","author":"Gheith","year":"2017","journal-title":"Exp Clin Transplant"},{"key":"2025121602285056000_10.1.e034940.33","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0b013e318238dab3"},{"key":"2025121602285056000_10.1.e034940.34","doi-asserted-by":"crossref","unstructured":"Witzke O , Nitschke M , Bartels M , et al . Valganciclovir Prophylaxis Versus Preemptive Therapy in Cytomegalovirus-Positive Renal Allograft Recipients: long-term Results after 7 Years of a Randomized Clinical Trial. Transplantation. 2018;102(5):876\u2010882. doi.","DOI":"10.1097\/TP.0000000000002024"},{"key":"2025121602285056000_10.1.e034940.35","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2012010100"},{"key":"2025121602285056000_10.1.e034940.36","doi-asserted-by":"crossref","first-page":"294","DOI":"10.2215\/CJN.07020714","article-title":"Randomized trial of valganciclovir versus valacyclovir prophylaxis for prevention of cytomegalovirus in renal transplantation","volume":"10","author":"Reischig","year":"2015","journal-title":"CJASN"},{"key":"2025121602285056000_10.1.e034940.37","doi-asserted-by":"publisher","DOI":"10.3851\/IMP1879"},{"key":"2025121602285056000_10.1.e034940.38","doi-asserted-by":"publisher","DOI":"10.5582\/bst.2011.v5.5.217"},{"key":"2025121602285056000_10.1.e034940.39","first-page":"2947","article-title":"Prophylactic therapy with valganciclovir in high-risk (cytomegalovirus D+\/R-) kidney transplant recipients: a single-center experience","volume":"42","author":"Montejo","year":"2010","journal-title":"Proceedings"},{"key":"2025121602285056000_10.1.e034940.40","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1016\/j.transproceed.2017.12.025","article-title":"Prevention of late-onset cytomegalovirus infection and disease in Donor-Positive\/Recipient-Negative kidney transplant recipients using low-dose valganciclovir","volume":"50","author":"Nanmoku","year":"2018","journal-title":"Transplant Proc"},{"key":"2025121602285056000_10.1.e034940.41","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.00836-08"},{"key":"2025121602285056000_10.1.e034940.42","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0b013e3181d54ba6"},{"key":"2025121602285056000_10.1.e034940.43","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.05219-11"},{"key":"2025121602285056000_10.1.e034940.44","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2009.020073"},{"key":"2025121602285056000_10.1.e034940.45","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1007\/s12185-012-1087-9","article-title":"Initial low-dose valganciclovir as a preemptive therapy is effective for cytomegalovirus infection in allogeneic hematopoietic stem cell transplant recipients","volume":"96","author":"Takenaka","year":"2012","journal-title":"Int J Hematol"},{"key":"2025121602285056000_10.1.e034940.46","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dks043"},{"key":"2025121602285056000_10.1.e034940.47","doi-asserted-by":"crossref","first-page":"1977","DOI":"10.1016\/j.transproceed.2012.06.013","article-title":"Role of liposomal amphotericin B prophylaxis after liver transplantation compared with fluconazole for high-risk patients. impact on infections and mortality within one year","volume":"44","author":"Perrella","year":"2012","journal-title":"Transplant Proc"},{"key":"2025121602285056000_10.1.e034940.48","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1097\/TP.0b013e3182577485","article-title":"Comparison of posaconazole versus Weekly amphotericin B lipid complex for the prevention of invasive fungal infections in hematopoietic stem-cell transplantation","volume":"94","author":"Chaftari","year":"2012","journal-title":"Transplantation J"},{"key":"2025121602285056000_10.1.e034940.49","doi-asserted-by":"publisher","DOI":"10.1016\/j.jinf.2016.06.011"},{"key":"2025121602285056000_10.1.e034940.50","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.12388"},{"key":"2025121602285056000_10.1.e034940.51","doi-asserted-by":"publisher","DOI":"10.2165\/00002018-200629050-00003"},{"key":"2025121602285056000_10.1.e034940.52","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1002127","article-title":"Reporting of adverse events in published and unpublished studies of health care interventions: a systematic review","volume":"13","author":"Golder","year":"2016","journal-title":"PLoS Med"},{"key":"2025121602285056000_10.1.e034940.53","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2018016493"},{"key":"2025121602285056000_10.1.e034940.54","doi-asserted-by":"crossref","unstructured":"Gagelmann N , Ljungman P , Styczynski J , et al . Comparative efficacy and safety of different antiviral agents for cytomegalovirus prophylaxis in allogeneic hematopoietic cell transplantation: a systematic review and meta-analysis. Biol Blood Marrow Transplant 2018.","DOI":"10.1016\/j.bbmt.2018.05.017"},{"key":"2025121602285056000_10.1.e034940.55","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djs259"},{"key":"2025121602285056000_10.1.e034940.56","doi-asserted-by":"publisher","DOI":"10.1001\/jama.287.21.2801"},{"key":"2025121602285056000_10.1.e034940.57","doi-asserted-by":"crossref","first-page":"673","DOI":"10.3346\/jkms.2015.30.6.673","article-title":"Reporting results of research involving human subjects: an ethical obligation","volume":"30","author":"Alley","year":"2015","journal-title":"J Korean Med Sci"},{"key":"2025121602285056000_10.1.e034940.58","doi-asserted-by":"crossref","unstructured":"Schulz KF , Altman DG . Statement: updated guidelines for reporting parallel group randomised trials. BMJ 2010;2010.","DOI":"10.1016\/j.ijsu.2010.09.006"},{"key":"2025121602285056000_10.1.e034940.59","unstructured":"Ben Goldacre HD , Powell-Smith A , Dale A , et al . The compare trials project."},{"key":"2025121602285056000_10.1.e034940.60","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-141-10-200411160-00009"},{"key":"2025121602285056000_10.1.e034940.61","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbmt.2011.04.004"},{"key":"2025121602285056000_10.1.e034940.62","doi-asserted-by":"publisher","DOI":"10.1111\/imj.12599"},{"key":"2025121602285056000_10.1.e034940.63","doi-asserted-by":"crossref","first-page":"965","DOI":"10.1007\/s40265-018-0930-6","article-title":"The evolution of lung transplant immunosuppression","volume":"78","author":"Ivulich","year":"2018","journal-title":"Drugs"},{"key":"2025121602285056000_10.1.e034940.64","doi-asserted-by":"crossref","first-page":"1974","DOI":"10.1111\/ajt.14238","article-title":"Chemotherapy and transplantation: the role of immunosuppression in malignancy and a review of antineoplastic agents in solid organ transplant recipients","volume":"17","author":"Krisl","year":"2017","journal-title":"Am J Transplant"},{"key":"2025121602285056000_10.1.e034940.65","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1016\/j.trre.2015.02.005","article-title":"Immunosuppressive therapies after heart transplantation \u2014 the balance between under- and over-immunosuppression","volume":"29","author":"S\u00f6derlund","year":"2015","journal-title":"Transplant Rev"},{"key":"2025121602285056000_10.1.e034940.66","doi-asserted-by":"publisher","DOI":"10.1111\/tri.12578"},{"key":"2025121602285056000_10.1.e034940.67","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1016\/j.idc.2018.04.003","article-title":"Strategies for antimicrobial stewardship in solid organ transplant recipients","volume":"32","author":"Hand","year":"2018","journal-title":"Infect Dis Clin North Am"},{"key":"2025121602285056000_10.1.e034940.68","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1007\/s40264-018-0648-0","article-title":"Interest in a mobile APP for two-way risk communication: a survey study among European healthcare professionals and patients","volume":"41","author":"de Vries","year":"2018","journal-title":"Drug Saf"},{"key":"2025121602285056000_10.1.e034940.69","first-page":"378","article-title":"Treatment of invasive fungal infections in high-risk haematological patients: what have we learnt in the past 10 years?","volume":"26","author":"Vallejo","year":"2013","journal-title":"Rev Esp Quimioter"},{"key":"2025121602285056000_10.1.e034940.70","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2008.02476.x"},{"key":"2025121602285056000_10.1.e034940.71","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(14)70036-2"},{"key":"2025121602285056000_10.1.e034940.72","doi-asserted-by":"crossref","first-page":"29","DOI":"10.4081\/jphr.2013.e29","article-title":"Who efforts to promote reporting of adverse events and global learning","volume":"2","author":"Larizgoitia","year":"2013","journal-title":"J Public health Res"},{"key":"2025121602285056000_10.1.e034940.73","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.00015-13"},{"key":"2025121602285056000_10.1.e034940.74","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmi.2016.06.021"},{"key":"2025121602285056000_10.1.e034940.75","doi-asserted-by":"crossref","first-page":"1294","DOI":"10.1111\/ctr.12821","article-title":"Medication understanding, non-adherence, and clinical outcomes among adult kidney transplant recipients","volume":"30","author":"Patzer","year":"2016","journal-title":"Clin Transplant"},{"key":"2025121602285056000_10.1.e034940.76","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1016\/j.amjsurg.2017.01.026","article-title":"Exploring the usage of a mobile phone application in transplanted patients to encourage medication compliance and education","volume":"214","author":"Zanetti-Yabur","year":"2017","journal-title":"Am J Surg"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2019-034940","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T10:29:03Z","timestamp":1765880943000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2019-034940"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,1]]},"references-count":76,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2020,1,7]]},"published-print":{"date-parts":[[2020,1]]}},"alternative-id":["10.1136\/bmjopen-2019-034940"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2019-034940","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"type":"print","value":"2044-6055"},{"type":"electronic","value":"2044-6055"}],"subject":[],"published":{"date-parts":[[2020,1]]}}}