|Year : 2020 | Volume
| Issue : 1 | Page : 41-53
Instructions for kidney recipients and donors (In English for medical providers and in Arabic for patients and donors)
Ziad Arabi, Basmeh Ghalib, Ibrahim Asmari, Mohammed Gafar, Syed Alam, Mohamad Abdulgadir, Ala AlShareef, Awatif Rashidi, Mohammed Alruwaymi, Abdulrahman Altheaby
Adult Transplant Nephrology, The Organ Transplant Center at King Abdulaziz Medical City, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
|Date of Web Publication||23-Jan-2020|
Dr. Ziad Arabi
Adult Transplant Nephrology, King Abdul-Aziz Medical City (KAMC), Riyadh.
Kingdom of Saudi Arabia
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Medical providers are often asked by their kidney recipients and donors about what to do or to avoid. Common questions include medications, diet, isolation, return to work or school, pregnancy, fasting Ramadan, or hajj and Omrah. However, there is only scant information about these in English language and none in Arabic. Here, we present evidence-based education materials for medical providers (in English language) and for patients and donors (in Arabic language). These educational materials are prepared to be easy to print or adopt by patients, providers, and centers.
Keywords: Arabic, education, instructions, kidney donors, kidney recipients, lifestyle, Muslim
|How to cite this article:|
Arabi Z, Ghalib B, Asmari I, Gafar M, Alam S, Abdulgadir M, AlShareef A, Rashidi A, Alruwaymi M, Altheaby A. Instructions for kidney recipients and donors (In English for medical providers and in Arabic for patients and donors). Avicenna J Med 2020;10:41-53
|How to cite this URL:|
Arabi Z, Ghalib B, Asmari I, Gafar M, Alam S, Abdulgadir M, AlShareef A, Rashidi A, Alruwaymi M, Altheaby A. Instructions for kidney recipients and donors (In English for medical providers and in Arabic for patients and donors). Avicenna J Med [serial online] 2020 [cited 2020 Jul 8];10:41-53. Available from: http://www.avicennajmed.com/text.asp?2020/10/1/41/276517
| INSTRUCTIONS FOR KIDNEY GRAFT RECIPIENTS (PROVIDERS’ INFORMATION)|| |
Medication side effects:
- Immunosuppression medications:
- These medications are to protect against rejection of the transplanted kidney.
- These medications include tacrolimus (Prograf or FK) and mycophenolate mofetil (MMF) (CellCept) and prednisolone.
- These medications are to be maintained for the life of the graft.
- Stopping these medications will lead to rejection and possibly loss of the graft.
- These medications must be taken at the exact time prescribed by your doctor.
- Prophylactic antimicrobial medications:
- These medications are to decrease the risk of opportunistic viral, bacterial, and fungal infections.
- These medications include valganciclovir (Valgan), nystatin, and Bactrim.,
Tacrolimus (Prograf or FK) may cause diabetes, hypertension, alopecia, tremor, and renal insufficiency.MMF (CellCept) may cause low white blood count.Prednisolone may cause high blood sugar.,,Clinic follow-up and laboratory testing:
Potential complications of renal transplant include rejection, infections, internal urine leak from ureter, renal artery stenosis, ureteric stricture, diabetes, tremor, recurrence of the original disease, bone disease, or cancer such as lymphoma.Diet: Renal transplant recipients frequently encounter significant weight gain after transplantation. To prevent gaining weight after transplantation, you are strongly advised to balance the calorie intake with especial attention to the amount of carbohydrates consumed. You are advised also to drink enough fluid (2–3L/day) but excessive fluid intake is not needed.,,,,,,,,,,
- You need to keep your appointments for clinic visits and laboratory testing.
- Do not take tacrolimus (Prograf or FK) in the morning of your labs but take it right away after the blood draw.
- Remember to have an appointment for the stent removal, which is typically removed by urologist in 1–2 months after transplant. Stent removal does not require overnight stay nor general anesthesia.
- Remember that staples are typically removed 3 weeks after the surgery.
Low salt diet is advised in most of the patients. Magnesium- and phosphorous-rich diet are often recommended. Potassium restriction is not required in most of the patients.
Examples of magnesium-rich food: dark leafy greens, seeds, beans, fish, whole grains, nuts, dark chocolate, yogurt, and bananas.
Examples of phosphorous-rich food: protein-rich foods such as meats, poultry, fish, nuts, beans, and dairy products. Some bottled beverages may also have high content of phosphate additives.
Examples of potassium-rich food: leafy greens, potato, dates, banana, tomato, orange juice, and cardamom.Exercise and sports:
Work/school: Most of the renal transplant recipients will be able to go back to school/work in 2–3 months. Strenuous activity and exposure to the hot weather should be avoided.,,,,,Isolation: You should avoid contact with sick. You should wash hands frequently and not share personal items with family. You are also advised to avoid crowded area; however, strict isolation in a single room is usually not necessary as it can lead to social isolation and depression.,,,,,Fasting during Ramadan: Fasting Ramadan does not adversely affect kidney function as shown by several small studies. In these conditions, fasting might be allowed after the first 1–2 years. Special care might be given to the timing of medications and drug levels. You may try initially to fast every other day then advance as tolerated. You must break your fast if you feel exhausted or dehydrated. You must consult with your nephrologist before attempting to fast.,,,,,,,,,,,,,,,,Fasting of renal transplant patients with diabetes: In addition to the previously mentioned precautions, patients with diabetes on medications or insulin need to adjust their medications or insulin requirement, monitor their blood sugar closely, and never miss Suhour. Patients must consult with their provider before attempting to fast. Fasting by patients with renal transplant having type 1 diabetes mellitus is trickier and requires consultation from endocrinologist.,,,,,,Omrah: Owing to the risk of upper respiratory infection (URI), it is recommended to postpone Omrah for at least 6–12 months after renal transplant. Omrah during peak hours is not recommended. Extra precautions should be taken against airborne and foodborne infections.,,,,,Hajj: Owing to the very high risk of URI, it is recommended to perform hajj before renal transplant. For those who have never performed the obligatory hajj, it is recommended to delay hajj at least 1-year posttransplant. Patients are to weigh their potential risks. Frail or elderly on immunosuppressants might be excused from hajj.,,,,,Marital relations: In 2–3 months after transplant, most of the patients can resume marital relations once the surgical incision is healed and the urinary stent is removed.Fertility in male renal transplant recipients: Fertility improves after kidney transplantation in many patients. Certain medications should be avoided. For example, sirolimus (Mammalian target of rapamycin (mTOR) inhibitors) can affect sperm genesis and fertility. Patients are advised to consult with their doctor.,,,,,,,Pregnancy after kidney transplant:
- Exercise is associated with improved quality of life and patients are encouraged to follow regular exercise program.
- Walking is encouraged in the immediate postsurgical period.
- Noncompetitive sports (such as cycling and jogging) can be resumed once the surgical pain resolves (after 1–2 months).
- Competitive sports (such as boxing and karate) should be avoided because of risk of direct trauma to the kidney.
- Driving can be resumed once the surgical pain resolves (after 1–2 months).
Vaccinations: Yearly vaccination against flu (inactive) is highly recommended. Pneumonia vaccination is also recommended.Signs and symptoms of rejection: There are no specific signs or symptoms for rejection in most of the cases. Blood tests are the only ways to find out. Patients are strongly advised to adhere to their medications and their routinely scheduled laboratory tests. In early stages decreased urine output, fever, vomiting, pain at the site of the graft or lathery can appear in late stages.You must report to the emergency room in case of fever, decreased amount of urine, vomiting, inability to take medications, or not feeling well in general [Table 1] and [Table 2].,
- Women of childbearing age should be alerted that fertility may improve after kidney transplantation.
- Oral contraceptive pills can be used as a contraceptive method after an appropriate medical consultation.
- The intrauterine devices are generally discouraged because of increased risk of infection with immunosuppressants.
- Pregnancy after renal transplant can negatively affect both the transplanted kidney and the fetus (low birth weight and preterm delivery).
- Women should wait for at least 1–2 years before attempting pregnancy, renal function must be stable and without significant proteinuria nor a recent rejection.
- Many posttransplant women who already have children before transplant may prefer not to have any further children over risking the fetus and the transplanted kidney.
- Pregnant transplant recipient should be followed up by obstetrician experienced in high-risk pregnancies.
- With close medical follow-up, most of the pregnancies after renal transplantation have successful outcome.
- Some medications can negatively affect the fetus:
- MMF is teratogenic and should be stopped or replaced with azathioprine before pregnancy is attempted (allow 12 weeks window before contemplating pregnancy after switching from MMF to AZA).
- mTORi should be discontinued before pregnancy is attempted.
- Angiotensin converting enzyme inhibitors (ACE) /angiotensin-receptor blockers (ARBs) should be discontinued or replaced with other class of medication during pregnancy.
- Calcineurin inhibitor, prednisone, and AZA are generally safe during pregnancy.
- Delivery in transplanted patient can be through vaginal route if there is no indication for cesarian section.,,,,,,,,,,,,,,,
| INSTRUCTIONS FOR KIDNEY DONORS (PROVIDERS’ INFORMATION)|| |
- Work: You can return to work once the surgical pain resolves (after 1–2 months). Please consult with your surgeon.
- Donors should avoid heavy lifting.
Driving can be resumed once the surgical pain resolves (after 1–2 months).Medications:
- Walking is encouraged immediately after surgery.
- Noncompetitive sports (walking and cycling) can be resumed once the surgical pain resolves (after 1–2 months).
- Competitive sports such as boxing and karate should be avoided.
- Please consult with your surgeon for further instructions.
- Acetaminophen is considered as a safe painkiller that can be used after kidney donation.
- Frequent use of nonsteroidal anti-inflammatory drugs is discouraged but sporadic use is likely to be safe in most of the donors.
- Please alert your doctor if you are undergoing imaging with intravenous contrast (even though oral contrast is mostly okay if clinically needed).
- Most of the donors can enjoy fasting once their renal functions stabilize (2–3 months after kidney donation).
- Donors might initially try to fast every other day and then progress to daily fasting.
- Donors must break their fast if they are exhausted or dehydrated.
- Donors should not miss Suhour and should have enough fluid intake after iftar [Table 3] and [Table 4].,,
Disclaimer: This educational material was designed to aid the renal transplant team to provide written educational material to their renal transplant recipients. This document should not be construed as dictating exclusive courses of recommendations. Patients are advised to consult with their health providers for more specific advice. Variations from these educational materials may be warranted in actual practice based on individual patient characteristics and clinical judgment in unique care circumstances.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Arabi Z, Altheaby A, Elhassan A, Abdalla M, Farooqui M, Mateen A, et al
. Multinational survey of the advice given to Muslim kidney graft recipients by Muslim nephrologists about lifestyle and religious rituals with potential medical risk. Saudi J Kidney Disease Transplant (In Press).
Lexicomp I. Tacrolimus (systemic): Drug information. Available from: https://wwwuptodatecom/contents/tacrolimus-systemic-drug-information?source=autocomplete&index=1~4&search=Tacolim. [Last accessed on Jan 17 2018].
Lexicomp I. Mycophenolate mofetil (CellCept) and mycophenolate sodium (Myfortic): Patient drug information. Available from: https://wwwuptodatecom/contents/mycophenolate-mofetil-cellcept-and-mycophenolate-sodium-myfortic-patient-drug-information?search=mycophenolate%20patient%20info&source=panel_search_result&selectedTitle=1~148&usage_type=panel&kp_tab=drug_patient&display_rank=1. 2018. [Last accessed on Jan 15 2018].
Choi HY, Park HC, Ha SK. High water intake and progression of chronic kidney diseases. Electrolyte Blood Press 2015;13:46-51.
Clark WF, Sontrop JM, Macnab JJ, Suri RS, Moist L, Salvadori M, et al
. Urine volume and change in estimated GFR in a community-based cohort study. Clin J Am Soc Nephrol 2011;6:2634-41.
Strippoli GF, Craig JC, Rochtchina E, Flood VM, Wang JJ, Mitchell P. Fluid and nutrient intake and risk of chronic kidney disease. Nephrology (Carlton) 2011;16:326-34.
Sontrop JM, Dixon SN, Garg AX, Buendia-Jimenez I, Dohein O, Huang SH, et al
. Association between water intake, chronic kidney disease, and cardiovascular disease: A cross-sectional analysis of NHANES data. Am J Nephrol 2013;37:434-42.
Hebert LA, Greene T, Levey A, Falkenhain ME, Klahr S. High urine volume and low urine osmolality are risk factors for faster progression of renal disease. Am J Kidney Dis 2003;41:962-71.
Clark WF, Sontrop JM, Huang SH, Gallo K, Moist L, House AA, et al
. Effect of coaching to increase water intake on kidney function decline in adults with chronic kidney disease: The Ckd Wit randomized clinical trial. JAMA 2018;319:1870-9.
Magpantay L, Ziai F, Oberbauer R, Haas M. The effect of fluid intake on chronic kidney transplant failure: A pilot study. J Ren Nutr 2011;21:499-505.
Gordon EJ, Prohaska TR, Gallant MP, Sehgal AR, Strogatz D, Yucel R, et al
. Longitudinal analysis of physical activity, fluid intake, and graft function among kidney transplant recipients. Transpl Int 2009;22:990-8.
Weber M, Berglund D, Reule S, Jackson S, Matas AJ, Ibrahim HN. Daily fluid intake and outcomes in kidney recipients: Post hoc
analysis from the randomized ABCAN trial. Clin Transplant 2015;29:261-7.
Musso CG, Castañeda A, Giordani M, Mombelli C, Groppa S, Imperiali N, et al
. Hyponatremia in kidney transplant patients: Its pathophysiologic mechanisms. Clin Kidney J 2018;11:581-5.
Oguchi H, Tsujita M, Yazawa M, Kawaguchi T, Hoshino J, Kohzuki M, et al
. The efficacy of exercise training in kidney transplant recipients: A meta-analysis and systematic review. Clin Exp Nephrol 2019;23:275-84.
(NKF) NKF. 2012. After kidney transplant, do patients require complete isolation for 3 months? Available from: https://www.kidney.org/blog/ask-doctor/after-kidney-transplant-do-patients-require-complete-isolation-3-months. [Last accessed on 2018 Dec 25].
(NKF) NKF. Care after kidney transplant. Available from: https://www.kidney.org/atoz/content/immunosuppression. [Last accessed on 2018 Dec 25].
CENTER CUIM. Resuming life after kidney transplantation. Available from: https://columbiasurgery.org/kidney-transplant/resuming-life-after-kidney-transplantation. [Last accessed on 2018 Dec 25].
Center UoKM. Recovery after transplant surgery. Available from: https://iytmed.com/recovery-after-transplant-surgery/. [Last accessed on 2018 Dec 25].
UK GaSTN. Your guide to kidney transplantation. Available from: https://www.guysandstthomas.nhs.uk/resources/patient-information/kidney/kidney-transplantation-guide.pdf. [Last accessed on Dec 3 2019].
Matter Y, Sheashaa H, Refaie A. Effect of Ramadan fasting on patients with different kidney diseases: An updated review. 2018;18:1-5.
Qurashi S, Tamimi A, Jaradat M, Al Sayyari A. Effect of fasting for Ramadan on kidney graft function during the hottest month of the year (August) in Riyadh, Saudi Arabia. Exp Clin Transplant 2012;10:551-3.
Ibrahim IA, Hassan EA, Alkhan AM, Hussein MA, Alhabashi AF, Ali TZ, et al
. Ramadan fasting in kidney transplant recipients: A single-centre retrospective study. J Transplant 2018;2018:4890978.
Abdalla AH, Shaheen FA, Rassoul Z, Owda AK, Popovich WF, Mousa DH, et al
. Effect of Ramadan fasting on Moslem kidney transplant recipients. Am J Nephrol 1998;18:101-4.
Hejaili F, Qurashi S, Binsalih S, Jaradt M, Al Sayyari A. Effect of repeated Ramadan fasting in the hottest months of the year on renal graft function. Nephrourol Mon 2014;6:e14362.
Ghalib M, Qureshi J, Tamim H, Ghamdi G, Flaiw A, Hejaili F, et al
. Does repeated Ramadan fasting adversely affect kidney function in renal transplant patients? Transplantation 2008;85:141-4.
Ekinci I, Erkoc R, Gursu M, Dogan EE, Kilic E, Cebeci E, et al
. Effects of fasting during the month of Ramadan on renal function in patients with autosomal dominant polycystic kidney disease. Clin Nephrol 2018;89:103-12.
Hassan S, Hassan F, Abbas N, Hassan K, Khatib N, Edgim R, et al
. Does Ramadan fasting affect hydration status and kidney function in CKD patients? Ann Nutr Metab 2018;72:241-7.
Kara E, Sahin OZ, Kizilkaya B, Ozturk B, Pusuroglu G, Yildirim S, et al
. Fasting in Ramadan is not associated with deterioration of chronic kidney disease: A prospective observational study. Saudi J Kidney Dis Transpl 2017;28:68-75.
] [Full text]
Bragazzi NL. Ramadan fasting and chronic kidney disease: Does estimated glomerular filtration rate change after and before Ramadan? Insights from a mini meta-analysis. Int J Nephrol Renovasc Dis 2015;8:53-7.
Mbarki H, Tazi N, Najdi A, Tachfouti N, Arrayhani M, Sqalli T. Effects of fasting during Ramadan on renal function of patients with chronic kidney disease. Saudi J Kidney Dis Transpl 2015;26:320-4.
] [Full text]
Bakhit AA, Kurdi AM, Wadera JJ, Alsuwaida AO. Effects of Ramadan fasting on moderate to severe chronic kidney disease. A prospective observational study. Saudi Med J 2017;38:48-52.
NasrAllah MM, Osman NA. Fasting during the month of Ramadan among patients with chronic kidney disease: Renal and cardiovascular outcomes. Clin Kidney J 2014;7:348-53.
Cevik Y, Corbacioglu SK, Cikrikci G, Oncul V, Emektar E. The effects of Ramadan fasting on the number of renal colic visits to the emergency department. Pak J Med Sci 2016;32:18-21.
Al Mahayni AO, Alkhateeb SS, Abusaq IH, Al Mufarrih AA, Jaafari MI, Bawazir AA. Does fasting in Ramadan increase the risk of developing urinary stones? Saudi Med J 2018;39:481-6.
Imtiaz S, Salman B, Dhrolia MF, Nasir K, Abbas HN, Ahmad A. Clinical and biochemical parameters of hemodialysis patients before and during Islamic month of Ramadan. Iran J Kidney Dis 2016;10:75-8.
Salti I, Bénard E, Detournay B, Bianchi-Biscay M, Le Brigand C, Voinet C, et al
; EPIDIAR Study Group. A population-based study of diabetes and its characteristics during the fasting month of Ramadan in 13 countries: Results of the epidemiology of diabetes and Ramadan 1422/2001 (EPIDIAR) study. Diabetes Care 2004;27:2306-11.
Aziz KM. Effect of fasting Ramadan in diabetes control status—Application of extensive diabetes education, serum creatinine with HbA1c statistical ANOVA and regression models to prevent hypoglycemia. Recent Pat Endocr Metab Immune Drug Discov 2013;7:233-51.
Alawadi F, F R, Bashier A, Abdelgadir E, Al Saeed M, Abualkheir S, et al
. The impact of Ramadan fasting on glycemic control and kidney function in patients with diabetes and chronic kidney disease stage 3. 2017.
DiabetesUK. Available from: https://www.diabetes.org.uk/guide-to-diabetes/managing-your-diabetes/ramadan. [Last accessed on Dec 11 2018].
Society AD. Available from: https://diabetessocietycomau/documents/DARHCPLeaflet-Copypdf. [Last accessed on Jan 15 2018].
Hassanein M, Al-Arouj M, Hamdy O, Bebakar WMW, Jabbar A, Al-Madani A, et al
; International Diabetes Federation (IDF), in Collaboration with the Diabetes and Ramadan (DAR) International Alliance. Diabetes and Ramadan: Practical guidelines. Diabetes Res Clin Pract 2017;126:303-16.
Alzeer AH. Respiratory tract infection during Hajj. Ann Thorac Med 2009;4:50-3.
] [Full text]
Rashid H, Shafi S, Haworth E, El Bashir H, Memish ZA, Sudhanva M, et al
. Viral respiratory infections at the Hajj: Comparison between UK and Saudi pilgrims. Clin Microbiol Infect 2008;14:569-74.
health.govt.nz. Travelling for Hajj or Umrah. 2018. Available from: https://www.health.govt.nz/your-health/healthy-living/travelling/travelling-hajj-or-umrah. [Last accessed on Dec 3 2019].
Patel RR, Liang SY, Koolwal P, Kuhlmann FM. Travel advice for the immunocompromised traveler: Prophylaxis, vaccination, and other preventive measures. Ther Clin Risk Manag 2015;11:217-28.
Kotton CN, Hibberd PL; AST Infectious Diseases Community of Practice. Travel medicine and transplant tourism in solid organ transplantation. Am J Transplant 2013;13:337-47.
Kidney Disease: Improving Global Outcomes (KDIGO) Transplant Work Group. Am J Transplant. 2009;9:S1-155.
Highlights of prescribing information of CellCept. 2018. Available from: https://www.gene.com/download/pdf/cellcept_prescribing.pdf. [Last accessed on Dec 3 2019].
CellCept. CellCept [package insert]. San Francisco, CA: Genentech USA; 2012. Available from: https://www.gene.com/medical-professionals/medicines/cellcept. Last accessed on Dec 3 2019].
Kim M, Rostas S, Gabardi S. Mycophenolate fetal toxicity and risk evaluation and mitigation strategies. Am J Transplant 2013;13:1383-9.
Jones A, Clary MJ, McDermott E, Coscia LA, Constantinescu S, Moritz MJ, et al
. Outcomes of pregnancies fathered by solid-organ transplant recipients exposed to mycophenolic acid products. Prog Transplant 2013;23:153-7.
Midtvedt K, Bergan S, Reisæter A, Vikse B, Asberg A. Exposure to mycophenolate and fatherhood. Transplantation. 2017;101:e214-e217.
Morlidge MHGLCAC. Recommendations for men taking mycophenolate derivatives and pregnancy following MHRA recommendations. 2016. Available from: https://renal.org/wp-content/uploads/2017/06/mycophenolate-and-fathers-to-be-letter-may-2016da90a131181561659443ff000014d4d8.pdf. [Last accessed on Dec 3 2019].
Chittka D, Hutchinson JA. Pregnancy after renal transplantation. Transplantation 2017;101:675-8.
Shah S, Verma P. Overview of pregnancy in renal transplant patients. Int J Nephrol 2016;2016:4539342.
McKay DB, Josephson MA, Armenti VT, August P, Coscia LA, Davis CL, et al
; Women’s Health Committee of the American Society of Transplantation. Reproduction and transplantation: Report on the AST consensus conference on reproductive issues and transplantation. Am J Transplant 2005;5:1592-9.
McKay DB, Josephson MA. Pregnancy after kidney transplantation. Clin J Am Soc Nephrol 2008;3:S117-25.
Deshpande NA, James NT, Kucirka LM, Boyarsky BJ, Garonzik-Wang JM, Montgomery RA, et al
. Pregnancy outcomes in kidney transplant recipients: A systematic review and meta-analysis. Am J Transplant 2011;11:2388-404.
Al-Khader AA, Al-Ghamdi, Basri N, Shaheen F, Hejaili, Flaiw, et al
. Pregnancies in renal transplant recipients–With a focus on the maternal issues. Ann Transplant 2004;9:62-4.
Al-Khader AA, Basri N, Al-Ghamdi, Shaheen, Hejaili, Flaiw, et al
. Pregnancies in renal transplant recipients–With a focus on babies. Ann Transplant 2004;9:65-7.
Al Duraihimh H, Ghamdi G, Moussa D, Shaheen F, Mohsen N, Sharma U, et al
. Outcome of 234 pregnancies in 140 renal transplant recipients from five middle eastern countries. Transplantation 2008;85:840-3.
Rose C, Gill J, Zalunardo N, Johnston O, Mehrotra A, Gill JS. Timing of pregnancy after kidney transplantation and risk of allograft failure. Am J Transplant 2016;16:2360-7.
EBPG Expert Group on Renal Transplantation. European best practice guidelines for renal transplantation. Section IV: Long-term management of the transplant recipient. Nephrology, Dialysis, Transplant 2002;17:1-67.
Imbasciati E, Gregorini G, Cabiddu G, Gammaro L, Ambroso G, Del Giudice A, et al
. Pregnancy in CKD stages 3 to 5: Fetal and maternal outcomes. Am J Kidney Dis 2007;49:753-62.
Bramham K, Nelson-Piercy C, Gao H, Pierce M, Bush N, Spark P, et al
. Pregnancy in renal transplant recipients: A UK national cohort study. Clin J Am Soc Nephrol 2013;8:290-8.
Kasiske BL, Zeier MG, Chapman JR, Craig JC, Ekberg H, Garvey CA, et al
.; Kidney Disease: Improving Global Outcomes. KDIGO clinical practice guideline for the care of kidney transplant recipients: A summary. Kidney Int 2010;77:299-311.
Sara Simonsen MWV. Grand multiparity. Available from: https://www.uptodate.com/contents/grand-multiparity/contributors. [Last accessed on Dec 21 2018].
Shivaswamy V, Boerner B, Larsen J. Post-transplant diabetes mellitus: Causes, treatment, and impact on outcomes. Endocr Rev 2016;37:37-61.
Kalantar-Zadeh K. What not to eat after nephrectomy. Renal Urol News2017. Available from: https://www.renalandurologynews.com/home/news/urology/kidney-cancer/what-not-to-eat-after-nephrectomy/. [Last accessed on Dec 3 2019].
Society AC. Fluids intake with one kidney. Available from: https://csn.cancer.org/node/220718. [Last accessed on Dec 25 2018].
[Table 1], [Table 2], [Table 3], [Table 4]