LITERATURE REVIEW 1

AN INTEGRATIVE LITERATURE REVIEW ON POST ORGAN TRANSPLANT MORTALITY DUE TO

RENAL FAILURE: CAUSES AND NURSING CARE

By

(Student’s Name)

Course Title

Lecturer’s Name

Institution’s Name

Institution’s Location

Date
 LITERATURE REVIEW 2

Table of Contents

ABSTRACT ................................................................................................................................... 3

Introduction ............................................................................................................................... 4

Methods ..................................................................................................................................... 6

Literature Search .................................................................................................................... 7

Quality Appraisal .................................................................................................................... 8

Data analysis........................................................................................................................... 8

Results ........................................................................................................................................ 9

Prediction model to mortality rates due to kidney transplantError! Bookmark not defined.

Post-Transplant diabetes mellitus (PTDM) and Patients survival ..........Error! Bookmark not

defined.

Reduction of the mortality rates through management and prevention of post-transplant

malignancies. ........................................................................... Error! Bookmark not defined.

Discussion................................................................................................................................. 16

Limitations of the review ......................................................................................................... 17

Recommendations ................................................................................................................... 18

Conclusion ................................................................................................................................ 18

Bibliography ............................................................................................................................. 19
 LITERATURE REVIEW 3

ABSTRACT

Chronic kidney disease is currently a global public health epidemic challenge affecting all

age groups. Most countries have reported having recorded an increase in the number of

people having infection per year. Grant et al., (2016) reported that organ transplant is

always associated with several post organ transplant challenges that when not properly

attended, may consequently lead to death1. Some of the resulting problems include

cardiovascular disease, immunosuppressive failures, and other infectious diseases.

Therefore, to prevent any successive complications, pre-transplant and post-transplant

nursing are highly vital.

The main objective of this integrative literature review is to examine post organ

transplant mortality due to renal failure relating to causes and nursing care practices.

Whittemore and Knafl’s used a five-staged comprehensive review approach that includes

problem identification, literature review, quality appraisal, data analysis, and presentation

of results2. There was the use of qualitative, quantitative, and mixed methods of data

collection. The study used a critical cohort appraisal skill for qualitative and quantitative.

1
1. Acuna, S.A., Fernandes, K.A., Daly, C., Hicks, L.K., Sutradhar, R., Kim, S.J. and Baxter,

N.N., 2016. Cancer mortality among recipients of solid-organ transplantation in

Ontario, Canada. JAMA oncology, 2(4), pp.463-469.

2
2. Andersen, M.H., Lønning, K., Bjørnelv, G.M.W. and Fagerström, L., 2016. Nursing

intensity and costs of nurse staffing demonstrated by the RAFAELA system: liver vs.

kidney transplant recipients. Journal of nursing management, 24(6), pp.798-805.

 LITERATURE REVIEW 4

From the researchers conducted, the qualitative methods provided valuable results.

However, the quantitative methods failed to work effectively with only two of them giving

the desirable outcome. According to Hilmi et al. (2015), pre-transplant and post-transplant

nursing cares are very crucial toward the prevention of post organ transplant3.

KEYWORDS: Quality of life, Pre-transplant nursing care, Post-transplant nursing care, renal

failure, and post organ transplant mortality.

Introduction

The latest results published by various research institutes showed that different

healthcare institutions annually record an increasingly growing number of patients

undergoing renal transplantation. According to the National Nephrology, Dialysis, and

Transplant system in Turkey, a report presented in the year 2016 puts Turkey as one of the

countries recording an increasing diagnosis of patients with kidney transplant problems4.

3
3. Barreto, A.G., Daher, E.F., Silva Junior, G.B., Garcia, J.H.P., Magalhães, C., Lima,

J.M.C., Viana, C.F. and Pereira, E.D., 2015. Risk factors for acute kidney injury and 30-

day mortality after liver transplantation. Annals of hepatology, 14(5), pp.688-694.

4
4. Dew, M.A., Rosenberger, E.M., Myaskovsky, L., DiMartini, A.F., Dabbs, A.J.D.,

Posluszny, D.M., Steel, J., Switzer, G.E., Shellmer, D.A. and Greenhouse, J.B., 2015.

Depression and anxiety as risk factors for morbidity and mortality after organ

transplantation: a systematic review and meta-analysis. Transplantation, 100(5),

p.988.
 LITERATURE REVIEW 5

There was a diagnosis of patients where certain occasions lead to death, adding to the

records of post-organ transplant mortality across the globe (Grant et al., 2016). Nurses,

doctors, and other health practitioners including nursing research agencies such as AHRQ,

PubMed, and others conducted researches with aims of finding causes to the mortality

cases and nursing care practices.

However, despite this treatment becoming too risky, it is the most preferred method

of treatment of patients with end-stage renal disease (ESRD)5. There are other possible

resolutions besides undergoing kidney transplantation such as renal replacement,

haemodialysis, and peritoneal dialysis3. However, many diagnoses of the disease are risky

thus have lowers the quality of life, cost of health care services, and survival chances.

Therefore, this makes kidney transplant as the only available standard treatment to most of

the people around the world. The most discouraging reports departing in every country

within the continent is that the number of patients diagnosed with end-stage renal disease

keeps on growing on a daily basis. According to Acuna, Fernandes, Daly, Hicks, Sutradhar,

Kim, and Baxter (2016), the first successful kidney transplant was in the year 1975 in Turkey

to an 18-year-old patient, with the donor being at the age of 48 years old 4. Contrary,

another kidney transplant was carried out in 1978 with the donor deceases. Both of the

treatment operations were conducted in Turkey by the Hibernal and associates. Hence, post

5
5. Dienemann, T., Fujii, N., Li, Y., Govani, S., Kosaraju, N., Bloom, R.D. and Feldman,

H.I., 2016. Long‐term patient survival and kidney allograft survival in post‐transplant

diabetes mellitus: a single‐center retrospective study. Transplant International,

29(9), pp.1017-1028.
 LITERATURE REVIEW 6

organ transplant mortality is not a problem, but an issue with laid backgrounds obtained

from different scenarios across the globe. This challenge comes in through certain ways and

procedures which are unperceivable. They include both individual health care practices and

may as well include nursing care practices carried out before the treatment and after the

treatment (pre-transplant and post-transplant nursing care practices) respectively (Acuna,

Fernandes, Daly, Hicks, Sutradhar, Kim, and Baxter, 2016)6. The core responsibility of this

integrative literature review is to conduct a simple critical analysis of the literature available

concerning the mortality challenge. The facts based on the causes and nursing practices that

may lead to post organ transplant mortality.

Aim of the Review

The main objective of this integrative literature review is to examine the post-organ

transplant mortality due to renal failure due to causes and nursing care practices. Another

aim of the review was to analyse the causes of renal failure disease, and the various nursing

care practices that contribute to the disease.

Methods

The methodology involved the application of the integrated research methods of

Whittemore and Knafl’s, which guaranteed the use of both qualitative and quantitative

6
6. Forsberg, A., Cavallini, J., Fridh, I. and Lennerling, A., 2016. The core of social

function after solid organ transplantation. Scandinavian journal of caring

sciences, 30(3), pp.458-465.

 LITERATURE REVIEW 7

research methods7. The combination of the two methods allows an insightful analysis and

description of data besides the easy comparison that we can make between the available

phenomena of perceptions of items. The research methodology takes a procedural five-path

way towards arriving at desirable results. These five paths include problem identification,

literature search, quality appraisal, analysis of data, and the presentation of the result8.

Literature Search

In order to obtain valid literature, various databases were visited in which the

qualitative and quantitative analysis was applied to help in acquisition of the desirable

literature sources. A time interval between 2015 and 2019 was used in order to determine

the most current contemporary issues concerning the post organ transplant mortality within

the country and across the globe. This information helps in presenting the dynamics facing

7
7. Grant, J.L., Hawkins, C., Brooks, H., Palella Jr, F.J., Koppe, S.W., Abecassis, M.M. and

Stosor, V., 2016. Successful sofosbuvir-based therapy in HIV/HCV co-infected liver

transplant recipients with recurrent HCV infection. AIDS (London, England), 30(1),

p.93.

8
8. Hilmi, I.A., Damian, D., Al-Khafaji, A., Planinsic, R., Boucek, C., Sakai, T., Chang, C.C.

and Kellum, J.A., 2015. Acute kidney injury following orthotopic liver transplantation:

incidence, risk factors, and effects on patient and graft outcomes. BJA: British Journal

of Anaesthesia, 114(6), pp.919-926.

 LITERATURE REVIEW 8

the nursing care practices of kidney transplants and various modern approaches towards

treating end-stage renal disease (ESRD).

Quality Appraisal

Coming up with the best and suitable outcomes from the various resources reviewed

requires proper and intensive integrated approach in quality appraisal. In the determination

of the quality resource, five path integrated qualitative and quantitative appraisal

approaches were used together with the respective critical appraisal program skills9. The

mixed-method tool used had different items of questioning in which the individual response

was presented as weak, adequate, moderate, or strong. Only the qualitative appraisal tools

gave the desirable outcomes that ranged from moderate-to-strong. The step was followed

by the mixed-method appraisal tool and lastly followed by the quantitative appraisal

approach, which gives the least expected result. Its results did not show the relationship

between the researchers and the problem identified hence was not suitable for use in the

analysis.

Data analysis

During the analysis of the data, Whittemore and Knafl’s constant comparison

approaches were deployed. The procedure included reducing the data, display of the data,

9
9. Keyzer, C.A., de Borst, M.H., van den Berg, E., Jahnen-Dechent, W., Arampatzis, S.,

Farese, S., Bergmann, I.P., Floege, J., Navis, G., Bakker, S.J. and van Goor, H., 2016.

Calcification propensity and survival among renal transplant recipients. Journal of the

American Society of Nephrology, 27(1), pp.239-248.

 LITERATURE REVIEW 9

comparisons withdrawn, and verified conclusions. A series of comparison and similarity of

the data arrived on the four reviews presented below in the results.

Results

Briggs (2001) Netherlands

Aim

To determine the survival rate to the number of patients who undergo renal transplant. This

aimed at exploring the number of the patients who survived after the transplant of kidney

and other related organs. Briggs (2001) argues that there was considerable improvement in

the number of patients who underwent renal transplantation. Currently, one could say that

there was an expected survival rate of 95% within a year span and 90% survival rate within a

period of 2-3 years. Briggs (2001) further argued that the risk of deaths due to renal

transplant had reduced significantly in many patients10. However, the survival rate differs

from categories of patients. For instance, the survival rate for the patients aged 35 years

and above was 90% while the survival rate for the patients below the age of 35 years was

95% as per 1990 research results. This shows a deviation of 5% in the survival rate due to

the age factor.

10. 10 Li, A.H.T., Lam, N.N., Naylor, K.L., Garg, A.X., Knoll, G.A. and Kim, S.J., 2016. Early

hospital readmissions after transplantation: burden, causes, and

consequences. Transplantation, 100(4), pp.713-718.

 LITERATURE REVIEW 10

Methods

Qualitative data was used. The qualitative data used was done in comparison to factors such

as age, time intervals since the transplant, the transplant centre’s geographical position, the

era of the transplant, and presence of some other diseases. The data obtained was analysed

and tabulated with respect to each factor of transplant.

Roles

There was justification that considering the era of transplant was important in

understanding the influence of the changing immunosuppressive regimen on mortality rates

due to renal transplant.

Strengths and Weaknesses

The data collection was done inclusively to involve such factors as age, time, era, and

geographical position. There was also more information and relevant data analysis provided

on each factor. However, the researcher did not justify the sample size used during data

collection with respect to each factor.

Nastasi et al. (2018) America

Aim

Nastasi et al (2018) aim at getting the prediction model to the mortality rates due to kidney

transplantation. They argued that addition of objective measures of the potential factors

that can be modified have a positive correlation to predictions. Consequently, raising the
 LITERATURE REVIEW 11

interventions to the survival rate during kidney transplant11. As such, objective tests avoid

candidates’ bias and gives room for potential improvement of mortality rate prediction

(Nastasi et al., 2018).

Methods

The research made use of a well-validated, objective tool of assessment called Short

Physical Performance Battery (SPPB), which have lowered extremity functions. This

employed both qualitative and qualitative data with respect to age, sex, other diseases, and

body mass. The study sample size used was (N=645) from August 2009 to June 2016 from

Johns Hopkins Hospital, and (N=74) from February 2013 to December 2016 from The

University of Michigan. A total of (N=719) patients were studied.

Role of SPPB

The SPPB involved physical assessment of patients (speed of walking, standing balances and

repeated chair stand) and was measured at during kidney transplant admissions. The SPPB

projected that the SPPB-impaired patients regardless of age and sex showed a significant

post-kidney transplant mortality rate. The SPPB model therefore played a big role in renal

transplant mortality rate.

Strengths and Weakness

The strengths of the SPPB model included the use of the large sample size (N=719) and

included patients from different centres, covering different age brackets, races, body

11. 11 Li, A.H.T., Lam, N.N., Naylor, K.L., Garg, A.X., Knoll, G.A. and Kim, S.J., 2016. Early

hospital readmissions after transplantation: burden, causes, and

consequences. Transplantation, 100(4), pp.713-718.

 LITERATURE REVIEW 12

masses and presence of other diseases11. However, the covariates to be used in the model

were limited by the large sample size. In addition, the SPPB model had independent

correlation on the mortality rate with factors like age.

Dienemann et al. (2016)

Aim

Many observations, decades ago have linked post- transplant diabetes mellitus (PTDM) to

allograft losses and shorter patients’ survival12. Consequently, increment in the level of

awareness, health care improvements through nurses and modifications of the

immunosuppressive regimens have modified the association between patient’s survival and

post- transplant diabetes mellitus. Therefore, in this study, Dienemann et al. (2016) aimed

at examining the relationship between post- transplant diabetes mellitus (PTDM) and

patient and allograft survival. According to Dienemann et al. (2016), pre-transplant diabetes

mellitus in the kidney recipients have close association with increase in the risk of

cardiovascular infections. Consequently, higher rates of mortality due to renal related

complications. Furthermore, this study cohort sought to explore the roles of the severities

of post- transplant diabetes mellitus (PTDM) and clinical outcomes for time post-transplant

activities. In this regard, Dienemann et al. (2016) sought to explore the causes of Post organ

transplant mortality due to renal failures12.

12. 12 Naik, A.S., Josephson, M.A. and Chon, W.J., 2017. Postoperative Care of Renal

Transplant Recipients. In Anesthesia and Perioperative Care for Organ

Transplantation (pp. 297-307). Springer, New York, NY.

 LITERATURE REVIEW 13

Methods

The study reviewed the results of (N=209) consecutive number of patients during five years’

time lap, from 1974 to 1979. The mean age of the patients under study was 34.4 (ranging

between 4 years and 63 years). Eleven per cent of the patients under study had diabetes.

The study employed observation methods to collect the necessary data to the causes of

deaths due to renal failures. During the five years of observations and follow-ups, 34 % of

the patients under the study died from kidney related problems. The number of patients

who died after receiving transplant was 12 while the diabetic patients who died were 11.

Most of the deaths occurred 9 days to 59 months after kidney transplant.

This study therefore showed that the causes of death due to renal complications were

effects of other infections (22 patients), cardiovascular infections (11 patients), suicide (8

patients), gastrointestinal tract complications (7 patients), and miscellaneous causes of

death (4 patients). 18 deaths occurred within the first three months after kidney transplant,

10 deaths occurred between four to 12 months after transplant, while 26 deaths occurred

one year and above after the transplant.

Roles of the study

This study therefore was important- it came up with the causes of death due to renal failure.

The causes outlined in the study included infections, cardiovascular problems, suicide due to

stress and depression, gastrointestinal tract problems, malignant neoplasm issues, and

miscellaneous causes. Miscellaneous deaths were the deaths that were potentially easy to

prevent but occurred due to other causes such as aspiration and inter bronchial

haemorrhage13.
 LITERATURE REVIEW 14

Strengths and weakness

The study design was significantly strong due to the large sample size and the fact that the

data was collected over a long period of time. However, the PTDM study design may always

reduce the consequences of renal complications and thereby reducing the quality of data

desired.

Stallone et al. (2015)

Aim

The aim of this study was to focus on the management and preventions of post-transplant

malignancies due to kidney transplantation as a method of reducing the mortality rate

through nursing care to the kidney recipients13. According to Stallone et al. (2015),

developing immunosuppressive drugs is important in the success of allograft functions.

There were four areas that required considerations as a way of nursing care. These distinct

areas had potential and serious outcomes on recipient afters transplant. They include: (i)

risks of malignancy transmission to the recipients within donor organs, (ii) complications of

the previous malignancy that were diagnosed and treated, (iii) prevention of post-transplant

complications, and (IV) management of the other clinical complications14. There was

introduction of many immunosuppressive drugs during the 1990s on the basis to reduce the

incidences of acute rejection and the corresponding influences on the graft outcomes. Many

13. 13 Nastasi, A.J., McAdams‐DeMarco, M.A., Schrack, J., Ying, H., Olorundare, I.,

Warsame, F., Mountford, A., Haugen, C.E., González Fernández, M., Norman, S.P.

and Segev, D.L., 2018. Pre‐kidney transplant lower extremity impairment and post‐

kidney transplant mortality. American Journal of Transplantation, 18(1), pp.189-196.

 LITERATURE REVIEW 15

study cohorts have shown that malignancies are the major causes of mortality during kidney

transplant Stallone et al. (2015)

Methods

There was qualitative data analysis of the nursing care activities through the introduction of

immunosuppressive drugs. However, there was no quantitative data used in this regard.

Roles of the study;

The study focused on the nursing care practises that sought to reduce the mortality

rates due to renal transplant and related problems such as failure. It is necessary for the

nurses to avoid organ transplant from donors with any malignant disease 14. In relation to

this, there should be clinical analysis and medical examination of the organ donors to avoid

such related malignancies in the recipients. In addition, there should be retrospective

analysis of pre-existing neoplastic diseases on the recipients. Such patients should not

undergo kidney transplant. Patients having risk of developing malignancies should also not

undergo kidney transplants. In addition, as a nursing care practise, there should be use of

anti-proliferative drugs. As such, immunosuppressive drugs like Azathioprine have been

used during clinical transplant.

14. 14 Rosenberger, E.M., DiMartini, A.F., Dabbs, A.J.D., Bermudez, C.A., Pilewski, J.M.,

Toyoda, Y. and Dew, M.A., 2016. Psychiatric predictors of long-term transplant-

related outcomes in lung transplant recipients. Transplantation, 100(1), p.239.

 LITERATURE REVIEW 16

Strengths and weakness

The study gives comparative qualitative data that focuses on the prevention of

mortality rates due to kidney transplant. However, there was no clear quantitative data that

showed the effectiveness of such nursing practises.

Discussion

There are many cases of mortalities due to renal transplant outcomes in the world.

According to Dew at al. (2016), many countries have put much emphasis on the incidences

and prevalence of such deaths and sought to know the causes of death due to kidney

transplants and the related nursing care practices that function as management and

preventive mechanisms for the deaths15. Some of the cases highlighted here were:

I. effects of other infections

ii. Malignancies (malignancies can may from the donors)

iii. Cardiovascular infections

iv. Suicide due to stress and depression of renal complications

V. gastrointestinal tract complications

vi. Miscellaneous causes of death

15. 15 Stallone, G., Infante, B. and Grandaliano, G., 2015. Management and prevention of

post-transplant malignancies in kidney transplant recipients. Clinical kidney journal,

8(5), pp.637-644.
 LITERATURE REVIEW 17

Some of the nursing care strategies that would help reduce the prevalence of such

mortalities include:

I. clinical analysis of organ donors before undertaking transplant. (Forsberg, Cavallini,

Fridh, and Lennerling, 2016)

ii. Medical examination of the donors

iii. Retrospective analysis of pre-existing neoplastic diseases on the recipients that

should undergo kidney transplant (Turner, Burns and Tranter, 2018)

iv. Use of immunosuppressive drugs (Andersen, Lønning, Bjørnel and Fagerström, 2016)

Limitations of the review

As the case of any other research study, there exist some limitations to the

interpretation of the study results. The study did not include the integration of

computerized data, and information and thus, there might be some inconsistencies in the

data. In addition, it is not possible to get all the desired pieces of information16. The reason

is that some data are not authorized for every individual while some other study materials

are published in other foreign languages. In addition, reaching out to the public to extract

raw information within desired period was difficult.

16. 16 Turner, K., Burns, T. and Tranter, S., 2018. An evaluation of the nursing care of

renal transplant recipients: A qualitative study.

 LITERATURE REVIEW 18

Recommendations

This study has implications in the real-life situation and as such, preventing mortality

rates due to renal transplant is necessary. The following are the possible recommendations:

i. Creating awareness about the clinical use of immunosuppressive drugs during

transplant

ii. Nursing clinicians should complement the doctors’ roles through history taking;

clinical examination, therapeutic and pharmacology communications in order to reduce

delay in the delivery of health care services.

iii. Governments should create awareness through education and media on the

knowledge about the neoplastic disease before transplant. Patients with neoplastic diseases

should be encouraged not to undergo transplant.

Conclusion

Chronic renal infectious may in certain conditions results in a disease known as end-

stage renal disease. This consequently leads to renal failure that is most commonly

diagnosed by kidney transplants despite other available options like peritoneal dialysis and

haemodialysis15 (Naik, Josephson and Chon, 2017). However, this standard method of

diagnosis, kidney transplant, in some cases may lead to death of the patient involved. This

integrative literature review presented four causes of the post-organ transplant mortality

together with the nursing practices that may gears such an undesirable outcome before,

during or after the treatment. Some of these causes include the quality of life cost and

accessibility, pre-transplant nursing care practices and post-transplant nursing care

practices.
 LITERATURE REVIEW 19

Bibliography

1. Acuna, S.A., Fernandes, K.A., Daly, C., Hicks, L.K., Sutradhar, R., Kim, S.J. and Baxter,

N.N., 2016. Cancer mortality among recipients of solid-organ transplantation in

Ontario, Canada. JAMA oncology, 2(4), pp.463-469.

2. Andersen, M.H., Lønning, K., Bjørnelv, G.M.W. and Fagerström, L., 2016. Nursing

intensity and costs of nurse staffing demonstrated by the RAFAELA system: liver vs.

kidney transplant recipients. Journal of nursing management, 24(6), pp.798-805.

3. Barreto, A.G., Daher, E.F., Silva Junior, G.B., Garcia, J.H.P., Magalhães, C., Lima,

J.M.C., Viana, C.F. and Pereira, E.D., 2015. Risk factors for acute kidney injury and 30-

day mortality after liver transplantation. Annals of hepatology, 14(5), pp.688-694.

4. Dew, M.A., Rosenberger, E.M., Myaskovsky, L., DiMartini, A.F., Dabbs, A.J.D.,

Posluszny, D.M., Steel, J., Switzer, G.E., Shellmer, D.A. and Greenhouse, J.B., 2015.

Depression and anxiety as risk factors for morbidity and mortality after organ

transplantation: a systematic review and meta-analysis. Transplantation, 100(5),

p.988.

5. Dienemann, T., Fujii, N., Li, Y., Govani, S., Kosaraju, N., Bloom, R.D. and Feldman, H.I.,

2016. Long‐term patient survival and kidney allograft survival in post‐transplant

diabetes mellitus: a single‐center retrospective study. Transplant International,

29(9), pp.1017-1028.

6. Forsberg, A., Cavallini, J., Fridh, I. and Lennerling, A., 2016. The core of social function

after solid organ transplantation. Scandinavian journal of caring sciences, 30(3),

pp.458-465.
 LITERATURE REVIEW 20

7. Grant, J.L., Hawkins, C., Brooks, H., Palella Jr, F.J., Koppe, S.W., Abecassis, M.M. and

Stosor, V., 2016. Successful sofosbuvir-based therapy in HIV/HCV co-infected liver

transplant recipients with recurrent HCV infection. AIDS (London, England), 30(1),

p.93.

8. Hilmi, I.A., Damian, D., Al-Khafaji, A., Planinsic, R., Boucek, C., Sakai, T., Chang, C.C.

and Kellum, J.A., 2015. Acute kidney injury following orthotopic liver transplantation:

incidence, risk factors, and effects on patient and graft outcomes. BJA: British Journal

of Anaesthesia, 114(6), pp.919-926.

9. Keyzer, C.A., de Borst, M.H., van den Berg, E., Jahnen-Dechent, W., Arampatzis, S.,

Farese, S., Bergmann, I.P., Floege, J., Navis, G., Bakker, S.J. and van Goor, H., 2016.

Calcification propensity and survival among renal transplant recipients. Journal of the

American Society of Nephrology, 27(1), pp.239-248.

10. Li, A.H.T., Lam, N.N., Naylor, K.L., Garg, A.X., Knoll, G.A. and Kim, S.J., 2016. Early

hospital readmissions after transplantation: burden, causes, and

consequences. Transplantation, 100(4), pp.713-718.

11. Martin‐Gandul, C., Mueller, N.J., Pascual, M. and Manuel, O., 2015. The impact of

infection on chronic allograft dysfunction and allograft survival after solid organ

transplantation. American Journal of Transplantation, 15(12), pp.3024-3040.

12. Naik, A.S., Josephson, M.A. and Chon, W.J., 2017. Postoperative Care of Renal

Transplant Recipients. In Anesthesia and Perioperative Care for Organ

Transplantation (pp. 297-307). Springer, New York, NY.

13. Nastasi, A.J., McAdams‐DeMarco, M.A., Schrack, J., Ying, H., Olorundare, I.,

Warsame, F., Mountford, A., Haugen, C.E., González Fernández, M., Norman, S.P.
 LITERATURE REVIEW 21

and Segev, D.L., 2018. Pre‐kidney transplant lower extremity impairment and post‐

kidney transplant mortality. American Journal of Transplantation, 18(1), pp.189-196.

14. Rosenberger, E.M., DiMartini, A.F., Dabbs, A.J.D., Bermudez, C.A., Pilewski, J.M.,

Toyoda, Y. and Dew, M.A., 2016. Psychiatric predictors of long-term transplant-

related outcomes in lung transplant recipients. Transplantation, 100(1), p.239.

15. Stallone, G., Infante, B. and Grandaliano, G., 2015. Management and prevention of

post-transplant malignancies in kidney transplant recipients. Clinical kidney journal,

8(5), pp.637-644.

16. Turner, K., Burns, T. and Tranter, S., 2018. An evaluation of the nursing care of renal

transplant recipients: A qualitative study.