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REVIEW
Self-Management of Kidney Transplant Recipients
Research: A Comprehensive Bibliometric Analysis
Jiaao Lou
1,2,
*, Zhengbin Hu
1,
*, Menglin Yuan
1
, Rui Luo
1
, Tao Zhang
1
, Qifa Ye
1,3
, Xin Zhou
1
,
Bilong Feng
2
1
Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, National Quality Control Center for Donated
Organ Procurement, Hubei Key Laboratory of Medical Technology on Transplantation, Hubei Clinical Research Center for Natural Polymer Biological
Liver, Hubei Engineering Center of Natural Polymer-Based Medical Materials, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province,
430071, People’s Republic of China;
2
Department of Nursing, Zhongnan Hospital, Wuhan University, Wuhan, Hubei Province, People’s Republic of
China;
3
Research Center of National Health Ministry on Transplantation Medicine Engineering and Technology, The 3rd Xiangya Hospital of Central
South University, Changsha, Hunnan Province, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Xin Zhou, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, National Quality
Control Center for Donated Organ Procurement, Hubei Key Laboratory of Medical Technology on Transplantation, Hubei Clinical Research Center
for Natural Polymer Biological Liver, Hubei Engineering Center of Natural Polymer-based Medical Materials, Zhongnan Hospital of Wuhan University,
Wuhan, Hubei Province, 430071, People’s Republic of China, Tel +86 027-67813423, Email 13545133367@163.com; Bilong Feng, Department of
Nursing, Zhongnan Hospital, Wuhan University, #169, East Lake Road, Wuchang District, Wuhan, Hubei Province, 430071, People’s Republic of
China, Tel +86 027-67812888, Email fbl1019@126.com
Objective: This study analyzes research trends in self-management among kidney transplant recipients to inform future directions.
Methods: Bibliometric analysis was performed on 444 English articles related to self-management of kidney transplant recipients in
the Core Collection of Web of Science and Scopus databases using COOC 12.8, R software, Microsoft Excel 2019, VOSviewer, and
CiteSpace, with a focus on citation ranking, publication year, journal, country, organization, author, impact factor, and keywords.
Results: Four hundred and forty-four English articles revealed the United States as the leading publisher on kidney transplant
recipient self-management. Norway’s University of Oslo was the most productive institution, with Mirjam Tielen as the most prolic
author and SCHÄFER-KELLER as the most inuential. Belgium’s research was most cited. Emerging hotspots included medication
adherence, quality of life, psychological aspects, telemedicine, and health literacy in self-management research.
Conclusion: This study has identied the most inuential articles concerning the self-management of kidney transplant recipients,
documented the pivotal journals in the eld, and noted the most prolic countries, organizations, and authors contributing to the
literature, as well as highlighted upcoming research trends. Going forward, the research in kidney transplant recipient self-management
should explore the full potential of interdisciplinary integration, particularly by incorporating telemedicine into self-management
education. Future efforts should also be directed towards rening the existing post-transplant follow-up management systems and
enhancing lifelong care for kidney transplant recipients. Concurrently, there is a need to improve health literacy and self-management
capabilities among these patients, with the ultimate goal of improving their prognosis.
Keywords: self-management, kidney transplant, recipients, bibliometric analysis, visual analysis
Introduction
End-stage renal disease is recognized as a major public health problem, and kidney transplantation is a life-saving treatment for
patients with renal failure.
1
Because of the primary kidney disease of renal transplant recipients and immunosuppressive therapy
after renal transplantation, renal transplant recipients have a lot of related symptoms and high symptom burden, affecting their
quality of life.
2,3
Early diagnosis and preventive measures are necessary to reduce the occurrence of life-threatening complica-
tions and graft loss.
4
Self-management is a critical and challenging aspect of health management in kidney transplantation.
Kidney transplant recipients are required to adhere to long-term postoperative treatment and comply with medical instructions to
regulate their health behaviors for optimal outcomes.
5
Recipients with inadequate self-management exhibit higher rates of
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Journal of Multidisciplinary Healthcare Dovepress
Open Access Full Text Article
Received: 25 June 2024
Accepted: 5 December 2024
Published: 24 December 2024
rejection, post-transplant rehospitalization, and increased susceptibility to graft failure.
6
Individualized and professional self-
management programs are of great signicance to improve the quality of life of kidney transplant. In recent years, signicant
advancements and numerous research accomplishments have been made in the eld of self-management for renal transplanta-
tion. However, there is a lack of comprehensive bibliometric analysis to examine the current research status, identify key areas of
focus, and explore emerging research directions in this domain. Therefore, it is necessary to analyze the development status and
predict the development trend of self-management for kidney transplant recipients to help health care workers develop and
improve self-management programs for renal transplant recipients. Bibliometric analysis is a research method based on
mathematical statistics that claries academic productivity, summarizes research trends and hot spots, and predicts the devel-
opment direction of the research eld through qualitative and quantitative evaluation.
7,8
In this study, we aimed to analyze the
current status, hot spots, frontier directions of self-management of renal transplantation and puts forward targeted suggestions, in
order to provide reference for the development of self-management of kidney transplant recipients in the future.
Data and Methods
Data Source and Search Strategy
The articles were identied from a literature search using Core Collection of Web of Science (WOSCC), SCOPUS. We
performed a Boolean search on two lists with the operator “and”. Refer to the subject words and free words compiled by the
National Library of Medicine to formulate search words. The rst list included the following search structure: TS = (Kidney
Transplantation OR Renal Transplantation OR Renal Transplantations OR Transplantations, Renal OR Transplantation, Renal
OR Grafting, Kidney OR Transplantation, Kidney OR Kidney Transplantations OR Transplantations, Kidney). The second list
included the following search structure: TS = (self-management OR Self Care OR Self Efcacy OR Self-Control OR Self-
Regulation OR Self Control). We searched articles (Document Type) in English (Languages) published between the literature
from the establishment of the database to April 30, 2024.
Data Extraction and Collection
The data for this investigation were gathered from Core Collection of Web of Science (WOSCC), SCOPUS.
9
All the
information, including the number of publications and citations, titles, publication year, countries of publications,
institutions, journals, authors, keywords, and references, was collected. For more accurate bibliometric data analysis,
information such as countries, institutions, and keywords, was cleaned from the above-mentioned document data to
reduce the bias caused by some inherent weaknesses in these databases. Furthermore, the impact factor (IF) (2023) and
Journal citation reports (JCR) (2023) were obtained from the Web of Science.
Inclusion/Exclusion Criteria
The inclusion criteria were as follows: (a) articles as the type of literature; and (b) literature published in English; and (c)
literature form the establishment of the database to April 30, 2024. Duplicate publication and other types of publications
(such as meeting abstracts, editorial materials, letters and early access, etc) were excluded. The included literature was
manually checked by two authors independently. The deduplicated data is converted into a data format that can be
recognized by the software through the built-in data converter of CiteSpace. The format is converted by the software’s
own format conversion tool.
Bibliometric Analysis
The analysis conducted in this study utilized the Bibliometrix package in R software (4.3.11), Microsoft Excel 2019,
VOSviewer (1.6.18), and CiteSpace (6.2.R4.). We used Microsoft Excel 2019 to analyze the publication trends in the
literature and applied a polynomial-tting curve to predict future publication numbers. In addition, we also used the
Bibliometrix software package and VOSviewer to construct national cooperation networks, author cooperation networks,
institutional cooperation networks and document co-citation relationships. Finally, we created keyword bursts and
keyword cluster visualization maps using CiteSpace.
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Results
Bibliometric Analysis of Publication Years
A total of 444 articles were published before April 30, 2024. The annual volume of articles on self-management of
kidney transplant recipients showed a gradual upward trend. Overall, there was an overall upward trend in the number of
publications (Figure 1). The curve tting results show that the annual publications conform to a binomial formula,
expressed by the formula y = 0.0393×
2
+ 0.0695x. The polynomial-tting curve suggests that research in this area will
continue to grow, as indicated by an R
2
value of 0.6527 (Figure 1).
Analysis of Most Productive Countries/Regions
In this study, 229 countries contributed to the publication on self-management of renal transplant recipients. Table 1 lists
the 10 most productive countries. The United States (USA) published the highest number of papers. China was the next
leading country followed by NETHERLANDS. Publications from the USA were cited the most (Cited 2004 times).
Publications from SWITZERLAND had the highest average citation per paper (61.5), followed by AUSTRALIA (30.8).
There were large number of papers on multi-country publications (MCP) from the USA. The country co-authorship
analysis showed the level of interaction between inuential countries in this eld. With a threshold of at least 3
publications per country, 59 countries are selected, forming a graph of national collaborations with 322 links and
a total link strength (TLS) of 473 (Figure 2). Researchers from the USA displayed the highest collaboration level with
a TLS of 35, followed by the Netherlands (TLS = 20) and Germany (TLS = 17). Furthermore, USA maintained close
relations with Canada, Netherlands maintained close relations with Iran, Germany, whereas Belgium had strong
cooperative bonds with Brazil and Switzerland (Figure 2).
Figure 1 Annual trend chart of publications.
Description: This gure depicts the annual publication trend in the eld of Self-management of kidney transplant recipients Research from the establishment of the database
to April 30, 2024.It illustrates the number of scholarly articles published each year, providing a visual representation of the research activity and growth in this domain over
time.
Data Source: 444 English articles related to self-management of kidney transplant recipients in the Core Collection of Web of Science and Scopus databases, which are
renowned for their comprehensive indexing of scholarly publications. The data extraction period extends from January 1992 to April 2024, ensuring a thorough capture of
the research landscape in the eld.
Time Frame: The chart covers a period of 1992 to April 30, 2024.
Methodology: The data was compiled and plotted using Microsoft Excel 2019. The trend line was generated using the best-t linear regression model to highlight the overall
pattern of publication growth.
Y-Axis: Represents the number of publications per year, with the scale adjusted to accommodate the maximum number of publications recorded.
X-Axis: Represents the years from 1992 to April 30, 2024, with each Vertical bar corresponding to a year.
Trend Line: The solid line represents the linear trend of annual publications, indicating the rate of increase or decrease in publication output.
Markers: Individual data points are marked with Vertical bar, representing the actual number of publications for each year.
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Concerning the top 10 most frequent institutions, ERASMUS MC in the Netherlands is the leading institution,
followed by ERASMUS UNIVERSITY ROTTERDAM in the Netherlands (Table 2). Four were located in the USA, and
three were located in the Netherlands. The network of institutional collaborations is shown in Figure 3. Using a threshold
of at least three publications per institution, a total of 137 countries were selected, resulting in a chart with a total link
strength (TLS) of 164 (Figure 3). The institutions with the most collaborations included Northwestern University
(TLS=35), UNIVERSITY OF SYDNEY (TLS=23), and University of Pennsylvania (TLS=21).
Analysis of Inuential Authors
In terms of the most inuential authors, Tielen, Mirjam (TLS 85) rst and Weimar Willem (TLS 76) with 18 publications,
followed by Van Gelder (TLS 61) with 7 publications, Boonstra, Charlotte with 5 publications. The top three local
authors with the most citations are SCHÄFER-KELLER 115 times, DE GEEST 108 times, and DENHAERYNC 102
times. The network visualization maps for author co-authorship on kidney transplant recipient self-management are
shown in Figure 4. Remarkably, several authors tended to cooperate with a small group of collaborators, generating ve
major clusters of authors, each usually having two or three core authors.
Analysis of Most Active Journals
The results of this study provide an overview of the 10 most productive journals on kidney transplant recipient self-
management. The overview includes information such as journal name, number of publications, JCR ranking, IF for
the year 2023, and journal country. According to the JCR (2023) standards, more than half of these journals are classied
as Q1 or Q2 (see Table 3). Out of the 10 journals, ve are published in the USA and three are published in the UK. The
journal with the highest number of publications was TRANSPLANTATION PROCEEDINGS, followed by CLINICAL
TRANSPLANTATION. Table 3 presents the top 10 research areas ranked by publication counts.
Analysis of Highly Cited References
Table 4 provides a summary of the key attributes of the top 10 highly cited research papers focusing on self-management
among kidney transplant recipients. These studies were classied based on JCR 2023 standards, with 3 being cross
sectional studies, 1 prospective cohort study, 1 review, 2 systematic reviews, 1 Quasi-randomized controlled study and 2
Table 1 Top 10 Most Productive Countries on Self-Management of Renal Transplant Recipients
Rank Country Record Counts Total
Citations
Average Article
Citations
MCP
a
SCP
b
Frequency
1 USA 80 2004 25 6 74 0.184
2 CHINA
c
38 401 10.6 4 34 0.087
3 NETHERLANDS 19 470 24.7 3 16 0.044
4 KOREA 18 111 6.2 0 18 0.041
5 CANADA 15 332 22.1 3 12 0.034
6 AUSTRALIA 12 370 30.8 3 9 0.028
7 SWITZERLAND 12 736 61.5 1 11 0.028
8 IRAN 10 60 6 3 7 0.300
9UNITED KINGDOM 10 283 28.3 1 9 0.023
10 GERMANY 8 193 24.1 1 7 0.125
Notes: MCP
a
: articles in which all authors have the same country afliation are called SCP and are considered to represent intra-country
(within) collaboration. SCP
b
: Articles with authors having different country afliations are called MCP and are considered to represent the
international collaboration of that country.
c
CHINA: Including the mainland of China, Hong Kong.
Abbreviations: SCP, single-country publications; MCP, multiple-country publications.
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randomized controlled studies. The studies encompass various topics, such as patient compliance and education. Seven of
the 10 most cited articles provided evidence of noncompliance with medical advice in renal transplant recipients. PA
Frazier analyzed Correlates of noncompliance among renal transplant recipients, including follow-up compliance and
medication compliance, noncompliant with the follow-up regimen noncompliant with medications, stress was the
strongest predictor of both medication and follow-up compliance.
10
DEnhaerynck and Geest, who reported at different
times the Incidence, determinants, and consequences of noncompliance with immunosuppressive therapy in renal
transplant recipients.
11,12
Sabina De Geest conducted a pilot randomized controlled trial (RCT) to test the efcacy of
educational behavioral intervention in improving compliance in non-compliant RTx patients.
13
Jac Kee Low proposed
Figure 2 Network visualization map for Country collaboration.
Description: This network visualization map delineates the collaborative landscape among countries engaged in research on the self-management of kidney transplant
recipients. The map is constructed based on the collaborative countries data extracted from scholarly publications indexed in Web of Science and Scopus databases,
spanning from 1992 to April 2024.
Data Source: 444 English articles related to self-management of kidney transplant recipients in the Core Collection of Web of Science and Scopus databases, which are
renowned for their comprehensive indexing of scholarly publications. The data extraction period extends from January 1992 to April 2024, ensuring a thorough capture of
the research landscape in the eld.
Time Frame: The analysis encompasses a 32-year period, offering a longitudinal view of international research collaboration trends in the specied domain.
Methodology: VOSviewer (1.6.18) software was utilized to create the network visualization, employing bibliometric techniques to map and analyze the collaborative ties
between countries. The software’s clustering algorithm was applied to identify dense areas of collaboration, revealing the structure of the global research network.
Nodes: Each node represents a country that has contributed to the research on self-management of kidney transplant recipients. The size of the node is proportional to the
total number of publications or collaborations attributed to that country, reecting its research output and collaborative activity.
Edges: The edges connecting the nodes indicate Collaboration Network between countries. The thickness of the edges corresponds to the strength of collaboration, with
thicker lines signifying more robust research partnerships.
Clusters: Countries are grouped into clusters based on their collaborative ties. Each cluster represents a distinct community of countries that frequently collaborate with
each other in the eld of study.
Colors: The color coding of nodes and clusters facilitates the visualization of different research Country within the global network.
Labels: Country names are labeled for nodes with signicant research output or centrality in the network, aiding in the identication of key players in the eld.
Scale: The map is scaled to reect the density of collaborations, with the most active regions of the network appearing larger due to the concentration of collaborations.
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that interventions to improve medication compliance in adult renal transplant recipients require multi-level interventions
of behavior, education, and emotional changes, encouraging patients to participate in the development of management
plans and conduct self-monitoring.
14
Painter reported a randomized clinical trial of exercise after renal transplantation (RTX). Exercise training after RTX
results in higher levels of measured and self-reported physical functioning; however, exercise alone does not affect body
composition.
15
McGillicuddy investigated the attitudes of kidney transplant recipients toward mobile phone health
monitoring. Kidney transplant recipients had a positive overall attitude toward mobile phone-based health technology
(mHealth) and believed that mHealth provided an opportunity to increase self-efcacy and improve provider-driven
medical management.
16
Jamieson conducted Motivations, Challenges, and Attitudes to Self-management in Kidney
Transplant Recipients: A Systematic Review of Qualitative Studies and found that a multicomponent intervention of
personalized care plans, education, psychosocial support, decision aids, and self-monitoring tools can enhance self-
management skills and improve transplant outcomes.
17
Bibliometric Analysis of Co-occurring Keywords Cluster and Reference Burst
The frequency of a keyword indicates its signicance in inferring research hot spots in the eld. Keyword clustering is
reasonable when the S value is greater than 0.5 and convincing when the clustering module value exceeds 0.7. The
clustering structure is signicant when the clustering module value is greater than 0.3.
18
For kidney transplantation self-
management, the S value of the keyword clustering is 0.8799 and Q value is 0.5662, indicating high clustering credibility.
Figure 3 shows that the keyword clustering involves seven categories: # 0 “middle aged”; # 1 “quality of life”; # 2
“medication adherence”; # 3 “young adult”; # 4 “intentions”; # 5 “medical care”; # 6 “patient education”; # 7
“pharmacist”. Table 2 reveals that among the top 20 high-centrality keywords, including Kidney transplantation
(count, 210), quality of life (count, 113), medication adherence (count, 60), self-care (count, 60), renal transplantation
(count, 57), recipients (count, 55), self-management (count, 55). Based on Table 5 and Figure 5, the identied research
hotspots are compliance, quality of life, psychology, self-management across all ages, and education.
The clustering algorithm in CiteSpace software employs nominal terms to identify hot spots in subject research, allowing
researchers to discover signicant keywords in knowledge maps, analyze research trends, and determine research directions.
As depicted in Figure 6, the occurrence of explosive words is mainly concentrated in four stages. They are Stage 1: Focus on
Kidney Transplant Disease, Treatment Adherence (1998–2013) Stage 2: Improve Quality of Life through Risk Factor
Management (2013–2016) Stage 3: Focus on Psychology, Starting from Self-efcacy (2016–2020) Stage 4: Improve health
literacy through patient education, thereby enhancing self-management ability (2020–2024).
Table 2 Top 10 Most Frequent Institutions on Self-Management of Renal
Transplant Recipients
Afliation Country Articles Afliation Country Articles Count
ERASMUS MC The Netherlands 40
ERASMUS UNIVERSITY ROTTERDAM The Netherlands 28
FEINBERG SCHOOL OF MEDICINE USA 24
MCGILL UNIVERSITY Canada 24
UNIVERSITY SYSTEM OF OHIO USA 24
NORTHWESTERN UNIVERSITY USA 23
UNIVERSITY OF OSLO Norway 18
UNIVERSITY OF PENNSYLVANIA USA 18
UNIVERSITY OF SYDNEY AUSTRALIA 17
ERASMUS UNIVERSITY ROTTERDAM The Netherlands 17
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Figure 3 Network visualization map for institution collaboration.
Description: This network visualization map illustrates the collaborative relationships among institutions engaged in research on the self-management of kidney transplant
recipients. The map is constructed based on the collaborative institution data extracted from scholarly publications indexed in Web of Science and Scopus databases,
spanning from 1992 to April 2024.
Data Source: 444 English articles related to self-management of kidney transplant recipients in the Core Collection of Web of Science and Scopus databases, which are
renowned for their comprehensive indexing of scholarly publications. The data extraction period extends from January 1992 to April 2024, ensuring a thorough capture of
the research landscape in the eld.
Time Frame: The analysis encompasses a 32-year period, offering a longitudinal view of international research collaboration trends in the specied domain.
Methodology: VOSviewer (1.6.18) software was utilized to create the network visualization, employing bibliometric techniques to map and analyze the collaborative ties
between institutions. The software’s clustering algorithm was applied to identify dense areas of collaboration, revealing the structure of the global research network.
Nodes: Each node represents an institution that has contributed to the research on the self-management of kidney transplant recipients. The size of the node is proportional
to the total number of publications or collaborations attributed to that institution, reecting its research output and collaborative activity.
Edges: The edges connecting the nodes represent the collaboration between the institutions. The thickness of the edges corresponds to the strength of collaboration, with
thicker lines signifying more robust research partnerships.
Clusters: Institutions are grouped into clusters based on their collaborative ties. Each cluster represents a distinct community of institutions that frequently collaborate with
each other in the eld of study.
Colors: The color coding of nodes and clusters facilitates the visualization of different research institution within the global network.
Labels: Institution names are labeled for nodes with signicant research output or centrality in the network, aiding in the identication of key players in the eld.
Scale: The map is scaled to reect the density of collaborations, with the most active regions of the network appearing larger due to the concentration of collaborations.
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Discussion
This study utilizes bibliometric methods to analyze the developmental trends and research priorities concerning the self-
management of kidney transplant recipients. Moreover, it aims to identify the primary contributors to this eld of
research and signicant cited documents. The research outcomes provide valuable insights for studying the self-
management of renal transplant recipients, ignite ideas for future research, and offer benets to researchers by leveraging
the advantages of disciplinary integration and resource complementarity. These ndings contribute to the advancement
and improvement of self-management practices for individuals who have undergone renal transplantation.
Figure 4 Network visualization map for authors collaboration.
Description: This network visualization map depicts the collaborative ties among authors contributing to the eld of self-management of kidney transplant recipients. The
map is constructed based on co-authorship data extracted from scholarly publications indexed in Core Collection of Web of Science (WOSCC) and Scopus databases from
1992 to April 2024.
Data Source: 444 English articles related to self-management of kidney transplant recipients in the Core Collection of Web of Science and Scopus databases, which are
renowned for their comprehensive indexing of scholarly publications. The data extraction period extends from January 1992 to April 2024, ensuring a thorough capture of
the research landscape in the eld.
Time Frame: The analysis spans a 32-year period, providing an in-depth view of international research collaboration trends within the specied research domain.
Methodology: VOSviewer (1.6.18) software was employed to generate the network visualization, utilizing bibliometric techniques to map and analyze the collaborative
relationships between authors. The software’s clustering algorithm was applied to identify and visualize dense areas of collaboration, revealing the structure of the global
research network.
Nodes: Each node in the network represents an author who has contributed to the research on self-management of kidney transplant recipients. The size of the node is
proportional to the author’s total number of publications or collaborations, indicating their research output and level of engagement in the eld.
Edges: The edges connecting the nodes signify collaboration between authors. The thickness of the edges corresponds to the strength of collaboration, with thicker lines
indicating more frequent or impactful collaborative efforts.
Clusters: Authors are grouped into clusters based on their collaborative ties. Each cluster represents a distinct community of authors who frequently collaborate with each
other within the research domain.
Colors: Color coding of nodes and clusters helps visualize the different research authors in the global network.
Labels: Author names or initials are labeled for nodes with signicant research output or centrality in the network, aiding in the identication of key contributors in the eld.
Scale: The map is scaled to reect the density of collaborations, with the most active regions of the network appearing larger due to the concentration of collaborations.
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Temporal Trends on Kidney Transplantation Self-Management
The change in the number of academic publications serves as a vital indicator of evolving trends within a eld. The
global trend regarding the annual number of publications and the corresponding cumulative number demonstrated
a steady increase starting from the establishment of the database to April 30, 2024, with approximately fty percent
of these articles being published in the past six years. Furthermore, the curve-tting results further conrmed this trend.
The outcomes of the study highlighted that kidney transplantation self-management has emerged as an increasingly
signicant research topic, drawing substantial attention and scholarly effort. In recent years, advancements in surgical
techniques and the utilization of more effective immunosuppressive agents have led to improved patient survival rates. In
view of this, it is predictable that as countries worldwide engage in comprehensive research on self-management across
the entire kidney transplantation recipient life cycle, the number of publications in this domain will continue to increase.
General Knowledge Structure on Kidney Transplantation Self-Management
From the perspective of countries, the total number of publications serves as a crucial indicator reecting a country’s
productivity and output.
19
The USA held an overwhelmingly dominant position in terms of both publication count and
citation impact. The country co-authorship map revealed that the USA possessed the largest nodes and densest links,
demonstrated signicant national and international collaboration in kidney transplantation self-management research
suggesting its early involvement in research within this domain. The aforementioned outcomes underscored the
substantial contribution of the USA to research in kidney transplantation self-management.
Regarding the economy, among the top ten most socially representative countries, all except China and IRAN were
developed nations. This observation indicates a close correlation between the level of scientic research and economic
development. China emerged as the second-largest publishing country, a development that could be attributed to the
policy guidance from the organ transplantation community. The international organ transplantation community and its
Chinese counterpart exhibit mutual understanding, support, communication, and cooperation, leading to a growing
closeness in their relationship. Moreover, China is increasingly engaged in the establishment of an international
transplant governance system.
From the perspective of author, Lotka’s Law is utilized to analyze the distribution of authors in Social Network
Service research. According to the formula f(x)=f(1)/x
2
(where f(x) represents the number of authors who have written
x papers, and f(1) represents the number of authors who have written 1 paper), it becomes evident that authors who have
written only one paper constitute approximately 60% of the total proportion of all authors.
20
However, in this study, the
Table 3 Top 10 Most Active Journals on Self-Management of Renal Transplant Recipients
Sources Record Counts IF
(2023)
JCR
(2023)
JC
TRANSPLANTATION PROCEEDINGS 23 0.8 Q4 USA
CLINICAL TRANSPLANTATION 19 1.9 Q3 ENGLAND
PROGRESS IN TRANSPLANTATION 17 0.6 Q4 USA
TRANSPLANTATION 16 5.3 Q1 USA
JOURNAL OF CLINICAL NURSING 13 3.2 Q1 ENGLAND
PLOS ONE 12 2.9 Q1 USA
AMERICAN JOURNAL OF KIDNEY DISEASES 11 9.4 Q1 USA
PATIENT EDUCATION AND COUNSELING 10 2.9 Q2 IRELAND
PEDIATRIC TRANSPLANTATION 10 1.2 Q3 DENMARK
BMC NEPHROLOGY 9 2.2 Q2 ENGLAND
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Table 4 Characteristics of Top 10 highly Cited Literature on Self-Management of Renal Transplant Recipients
Title Author Public
Year
Journal DOI/PMID TC
per Year
Normalized
TC
IF
(2023)
JCR
(2023)
Article
Type
Global
Citations
Prevalence, consequences, and determinants of
nonadherence in adult renal transplant patients: a literature
review
DENHAERYNCK K 2005 TRANSPLANT
INTERNATIONAL
10.1111/j.1432-
2277.2005.00176.x
15.68 4.64 3.10 Q1 review 298
Incidence, determinants, and consequences of subclinical
noncompliance with immunosuppressive therapy in renal
transplant recipients
DEGEESTS 1995 TRANSPLANTATION 10.1097/00007890-
199502150-00006
9.20 1.00 5.30 Q1 cross-sectional
study
276
A study of treatment compliance following kidney
transplantation
KILEY DJ 1993 TRANSPLANTATION 10.1097/00007890-
199301000-00010
7.06 2.06 5.30 Q1 cross-sectional
study
219
Prevalence and risk factors of non-adherence with
immunosuppressive medication in kidney transplant patients
DENHAERYNCK K 2007 AMERIC AN JOURNAL OF
TRANSPLANTATION
10.1111/j.1600-
6143.2006.01611.x
8.33 3.06 8.90 Q1 prospective
cohort study
150
A randomized trial of exercise training after renal
transplantation
PAINTER PL 2002 TRANSPLANTATION 10.1097/00007890-
200207150-00008
6.43 2.66 5.30 Q1 randomized
controlled trial
148
Correlates of noncompliance among renal transplant
recipients
FRAZIER PA 1994 CLINICAL
TRANSPLANTATION
7865918 4.45 1.00 1.9 Q3 cross-sectional
study
138
Patient attitudes toward mobile phone-based health
monitoring: questionnaire study among kidney transplant
recipients
MCGILLICUDDY
JW
2013 JOURNAL OF MEDICAL
INTERNET RESEARCH
10.2196/jmir.2284 9.50 2.36 5.8 Q1 Quasi-
experimental
study
114
Motivations, Challenges, and Attitudes to Self-management
in Kidney Transplant Recipients: A Systematic Review of
Qualitative Studies
JAMIESON NJ 2016 AMERIC AN JOURNAL OF
KIDNEY DISEASES
10.1053/j.
ajkd.2015.07.030
12.56 4.68 9.4 Q1 systematic review 113
Interventions to improve medication adherence in adult
kidney transplant recipients: a systematic review
LOW JK 2015 NEPHROL DIAL TRANSPL 10.1093/ndt/gfu204 10.90 4.60 4.80 Q1 systematic review 109
Supporting medication adherence in renal transplantation
(SMART): a pilot RCT to improve adherence to
immunosuppressive regimens
DE GEEST S 2006 CLINICAL
TRANSPLANTATION
10.1111/j.1399-
0012.2006.00493.x
5.16 1.84 1.9 Q3 randomized
controlled trial
98
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proportion of authors who have published only one paper in English is 84.13%, which is signicantly higher than the
expected 60%. Therefore, no core contributors were formed. Analyzing the most inuential authors aids scholars in
comprehending both the current and potential cooperative relationships within their eld, both domestically and
internationally.
21
The co-citation analysis reveals that SCHÄFER-KELLE, DE GEEST, DENHAERYNC were hold
prominent positions, having received the highest number of citations. In conjunction with the surge of highly cited
literature and references, these papers were published earlier and have garnered more frequent citations. Thus, research-
ers can gain insight into authoritative trends in this eld by paying attention to its research direction.
From an institutional perspective, the University of Oslo in Norway was considered the leading institution in kidney
transplantation self-management. While the United States has the highest number of publications among countries, the
ERASMUS MC in Netherland holds the highest number of publications among institutions. This can be attributed to the
extensive presence of domestic research institutions in the United States. Consequently, fostering collaboration and
knowledge sharing among institutions across different regions and among authors within these institutions is imperative.
This is particularly crucial for promoting cooperation between colleges and clinical hospitals in various elds, such as
pharmacy, public health, clinical medicine, nursing, psychology, among others. These collaborative efforts will facilitate
cross-professional and cross-regional academic cooperation, ultimately enhancing the integration of scientic research
theory and its practical application. An encouraging trend is the growing attention from authors towards the study of
Table 5 Keywords in the Top 20 of Self-Management of Kidney
Transplantation
Rank Keyword Initial Occurrence Time Count
1 Kidney transplantation 1994 210
2 Quality of life 2002 113
3 Medication adherence 2014 60
4 Self-care 2014 60
5 Renal transplantation 2010 57
6 Recipients 1999 55
7 Self-management 2010 49
8 Adherence 1999 39
9 Nonadherence 2010 37
10 Kidney transplant 2004 36
11 Outcome 2010 32
12 Kidney graft 2015 31
13 Psychology 2014 31
14 Patient education 2012 30
15 Aged 2014 29
16 Questionnaire 2016 28
17 Depression 2008 27
18 Care 2006 25
19 Follow up 2003 24
20 Education 2019 19
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Figure 5 Keywords involved in the research for self-management of kidney transplantation Network of the main keywords in publications.
Description: This gure presents a co-occurrence network of the predominant keywords identied in the literature on self-management of kidney transplant recipients, spanning from
1992 to April 2024. The network map visualizes the intellectual structure and thematic interconnections within the research domain.
Data Source: 444 English articles related to self-management of kidney transplant recipients in the Core Collection of Web of Science and Scopus databases, which are renowned for their
comprehensive indexing of scholarly publications. The data extraction period extends from January 1992 to April 2024, ensuring a thorough capture of the research landscape in the eld.
Time Frame: The analysis encompasses a 32-year period, offering a longitudinal perspective on the thematic evolution and research priorities in self-management of kidney
transplant recipients.
Methodology: CiteSpace (6.2.R4) software was employed to perform bibliometric analysis and construct the keyword co-occurrence network. This software utilizes
algorithms to identify and map the frequency and proximity of keyword occurrences within the corpus of publications.
Nodes: Each node in the network represents a keyword that has been extracted and processed for signicance. The size of each node is indicative of the keyword’s
prominence, with larger nodes reecting higher frequency of occurrence in the literature.
Edges: The edges connecting nodes represent the co-occurrence relationships between keywords within the publications. The weight of the edges is proportional to the
strength of the association, with darker and thicker lines signifying more frequent co-occurrences.
Clusters: The network is partitioned into clusters, each representing a distinct thematic group of keywords. These clusters reveal the underlying thematic structures and
research areas within the eld.
Colors: Different clusters are assigned unique colors to distinguish between various thematic groups, aiding in the visual differentiation of research topics.
Labels: Keywords with signicant centrality within the network or high frequency of occurrence are labeled for clarity and ease of reference.
Scale: The network’s scale is designed to reect the density of connections, with densely connected areas indicating a concentration of thematic relevance and research activity.
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Figure 6 Citespace visualization of Burstness map of keywords on self-management of kidney transplant recipients.
Description: This gure presents a Citespace-generated burstness map of keywords, highlighting the dynamic trends and focal points within the self-management of kidney
transplant recipients research eld. The map visually represents the emergence of new research topics and the intensication of existing ones over the specied period.
Data Source: 444 English articles related to self-management of kidney transplant recipients in the Core Collection of Web of Science and Scopus databases, which are
renowned for their comprehensive indexing of scholarly publications. The data extraction period extends from January 1992 to April 2024, ensuring a thorough capture of
the research landscape in the eld.
Time Frame: The data encompasses a 32-year period from 1992 to April 2024, providing a comprehensive analysis of the evolution of research themes in the eld.
Methodology: Utilizing CiteSpace (6.2.R4), this visualization employs bibliometric techniques to detect signicant changes in keyword frequency, indicating periods of intense
research activity. The software’s burst detection algorithm identies keywords with a surge in usage, suggesting their importance in the research discourse.
Keywords: Each node on the map represents a keyword, with the size of the node correlating to the term’s burst strength, and the color indicating the year of the burst.
Larger nodes signify keywords with a more pronounced impact on the research eld.
Colors: The color coding of keywords corresponds to the year of their burst, with each color representing a specic time frame within the study period. This visual cue
allows for the tracking of the emergence and development of research trends.
Keywords: Keywords that have a signicant spike in frequency over a period of time.
Burst Strength: The intensity of the burst is represented by the numerical value of the keyword node, with larger numerical value indicating a stronger burst, reecting
a more signicant and rapid increase in the keyword’s usage within the research literature.
Year: The year of the burst is indicated by the color and the presence of a red circle around the keyword node, signifying the time when the keyword’s usage surged.
Begin and End: The beginning and end of the red segments or circles around the nodes represent the start and end years of the keyword’s burst period, providing insight into
the duration of each trend’s prominence.
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kidney transplantation self-management, which has resulted in strengthened relationships among authors in different
clusters over time.
Regarding the journals, most of the top 10 journals with the most outputs belonged to Q1 or Q2, most of them are
high-level journals in the eld of transplantation. However, the top journal was Q4. This may be related to the publication
frequency of periodicals. The quality of research in the eld of self-management of kidney transplantation is good, but
there are still uneven conditions. The countries of the journals were all developed countries in Europe and America.
Current research on kidney transplant self-management is mainly published in transplantation professional journals,
whereas there are also comprehensive journals such as PLOS ONE; nursing journals such as JOURNAL OF CLINICAL
NURSING; and medical education journals such as PATIENT EDUCATION AND COUNSELING. Furthermore, special
attention should be given to the literature published in these journals to gain insights into the latest advancements in this
eld and to identify future research directions.
Main Research Domains on Kidney Transplantation Self-Management
The study of self-management of renal transplant recipients can be divided into three aspects: patient compliance, Quality
of Life, outcome assessment of kidney transplant recipient psychology.
There are different denitions of noncompliance in kidney transplantation, including holistic non-adherence (HNA),
suboptimal-immunosuppressor levels (SIL), appointment non-adherence (ANA), procedure non-adherence (PNA) and
INA. Immunosuppressive non-compliance (INA) is the most studied denition in renal medicine research.
22
Medication
adherence is a critical topic in the eld of self-management of kidney transplantation. After kidney transplantation,
patients need to take immunosuppressants such as tacrolimus for a long time.
23
Adherence to immunosuppressive drugs
following renal transplantation is crucial for patient outcomes. Poor adherence is associated with a 1.5-fold increased risk
of acute rejection and a 65% greater likelihood of graft loss.
24
Kidney transplant recipients are often motivated to take
medications as prescribed, yet medication fatigue, depression, and amnesia can affect adherence.
25
Furthermore, poor
communication with medical staff post-discharge or interruptions in post-discharge care transitions can also impact
medication compliance. Therefore, addressing the needs, motivations, and obstacles of kidney transplant recipients who
have undergone long transplant times, received living donor kidneys, experienced complications, and undergone short
dialysis periods is a challenging research issue. Improving the preoperative medication behavior and beliefs of renal
transplant patients and scientically intervening in patients’ medication behavior are necessary to improve compliance
with immunosuppressive drugs and enhance clinical efcacy.
26,27
Improving medication non-adherence requires
a scientic, systematic, and multi-level approach. It is not just about solving the patient’s problem. It must integrate
patients, health care providers, families, and society, and consider socioeconomic and medical insurance factors. In-depth
exploration of more cost-effective immunosuppressant medication compliance management strategies for renal transplant
patients will improve patient outcomes.
Quality of life (QOL) is the focus of kidney transplantation self-management researchers. Currently, the expectations of
patients who undergo kidney transplantation have shifted beyond pain reduction and increasing activity levels towards
achieving a long-term active lifestyle and improved quality of life.
28
Health-related quality of life is a critical factor when
evaluating kidney transplant patients and serves as an essential indicator of kidney graft survival.
29
An inter-group comparison
of health-related quality of life after renal transplantation showed that patients reported higher HRQOL after successful KT
than before transplantation compared with patients undergoing dialysis. Compared with non-dialysis-dependent patients with
CKD stage 3–5, the HRQOL of KTRS patients also improved slightly. Shortly after the success of KT, HRQOL seemed to
return to the pre-CKD level, but these higher HRQOL levels did not last long. Future studies need to investigate the
intervention of modiable risk factors for HRQOL damage.
30
A study constructed a structural equation-based symptom
experience model to identify the symptom experience of kidney transplant recipients and explore the relationship between
antecedents, symptom experience and quality of life. The results showed that time since transplantation, complications,
immunosuppressants, and sense of coherence predicted symptoms experienced in the quality of life model, with coherence
having the strongest correlation with symptom experience. Habitual residence, economic burden, time after transplantation,
renal function, optimism and symptomatic experience accounted for more than 70% of the impact on quality of life. Therefore,
comprehensive health education should be carried out as soon as possible to encourage people to change their lifestyles, such
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as quitting smoking and exercising regularly. In addition, timely adjustment of drugs according to the different stages of
individual rehabilitation can reduce the side effects caused by multi-drug combination and drug interaction.
31
Considering the
comprehensiveness of the problems experienced by renal transplant recipients, self-management intervention is a natural way
to improve their quality of life. The optimization of quality of life requires the cooperation of the team, including patients and
medical team members. At present, members of the medical team focus on how to improve the biological response and
physical function after transplantation, and lack of relevant tools to guide patients to participate in optimizing the quality of
life.
32
In the future, longitudinal design can be used to investigate the quality of life over time during treatment, and to expand
the range of empowered people in the eld of renal transplantation by encouraging renal transplant recipients and family
members to participate in the whole disease recovery process. To enable patients, family members and medical staff cooperate
with each other to promote the recovery of kidney transplant recipients. At the same time, strengthen the combination of
articial intelligence and empowerment, through the combination of articial intelligence and empowerment therapy, so that
renal transplant recipients are empowered, actively participate in disease self-management, and improve the quality of life.
A comprehensive and systematic evaluation of the health status of kidney transplant recipients is of great signicance
for understanding the outcomes after transplantation. Currently, patient assessment tools include the Disease-Specic
Questionnaire for Kidney Transplant Patients,
33
Kidney transplantation understand tool,
34,35
kidney transplantation knowl-
edge assessment,
36,37
self-management scale,
38,39
kidney transplantation quality of life scale,
40
kidney transplant recipient
dietary self-management evaluation tool,
41
immunosuppression-related side effect symptom experience scale,
42
kidney
transplant recipient extended care effectiveness evaluation index system.
43
Future research in this domain should aim to
encompass a broader spectrum of inuencing factors and account for temporal dynamics to construct a forward-looking,
scientically rigorous, and comprehensive evaluation tool. This will facilitate a more accurate assessment of health
outcomes among kidney transplant recipients. Additionally, conducting multi-center and prospective external validation
studies will be crucial to establishing the tool’s broad applicability across different populations and settings. Such an
approach will not only validate the tool’s effectiveness but also highlight its versatility in various clinical contexts, thereby
showcasing its extensive utility in the eld of kidney transplantation research.
In addition to the above patient evaluation results, psychological evaluation should also be paid attention to after
kidney transplantation. The psychological evaluation of kidney transplantation is a crucial area of research within the
eld of kidney transplantation self-management. Previous studies have demonstrated that while patients’ physical and
social functioning generally improves after organ transplantation, their psychological outcomes do not exhibit sustained
positive changes.
44
Kidney transplant recipients experience varying degrees of adverse psychosocial experiences after
surgery, including stresses such as depression, anxiety, and reduced quality of life related to graft function, social
isolation, and nancial problems.
45
Long-term emotional problems escalate the risk of mortality, graft rejection, and
readmission.
46
To optimize graft function, clinicians, nurses, and psychologists should prioritize the psychosocial
adaptation of young and middle-aged kidney transplant recipients. They should guide these recipients to develop
a positive perception of their condition during the early postoperative period and identify potential negative conse-
quences. Identifying the sources of emotions, strengthening multidisciplinary collaborative interventions, and providing
support to early kidney transplant recipients are essential for their successful adaptation to post-transplant changes and
improvement of their social and psychological adaptability.
47
Future research on mental health in kidney transplantation
should prioritize investigating transplant preparation pathways, self-efcacy, disease awareness, social and family
support, and the inuence of health education on post-transplantation factors. This research should involve multi-
disciplinary experts such as surgeons, nephrologists, psychiatrists, and psychologists, with a specic focus on inter-
disciplinary interventions, collaborative discussions on transplant patient plans, conducting thorough psychosocial
assessments for kidney transplants, and adequately preparing patients for discharge.
48
Future Trends on Kidney Transplantation Self-Management
As lifestyles and disease spectrum change, health concepts have also shifted from “disease-centered” to “health-
centered”. Research on self-management of kidney transplantation has also gradually evolved from early focus on
disease and treatment compliance, risk factor management, to disease risk factor management and lifestyle treatment. In
addition to paying attention to physical conditions, more attention is paid to kidney transplant recipients full life cycle
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care and self-efcacy, and health literacy is improved through patient education to meet the self-management needs of
kidney transplant recipients.
Telemedicine Has a Broad Application Prospect in the Self-Management of Kidney
Transplant Recipient Education
The increasing popularity of smartphones and internet applications has made telemedicine a crucial means for transplant
recipients to acquire medical information and patient education. In the wake of pandemics, telemedicine possesses the
potential to make kidney transplant assessments and follow-up care more accessible, efcient, and convenient for both
recipients and donors, thereby having a lasting impact on the eld of kidney transplantation.
49
It is an important form to design
different solution development programs to enhance self-management behavior and make transplant patients follow a series of
self-management tasks. These programs are mainly divided into the following functional modules, including daily symptom
monitoring, drug management, appointment and access module, reporting and saving data, applying intelligent tools,
suggesting a healthy lifestyle module, physical activity management and rehabilitation, psychological indicators and training
and education functions. Among them, symptom monitoring and patient education are the most common functions and
abilities. Interventions based on information technology, such as mobile health, wearable devices and computer systems, can
improve the self-management of renal transplant recipients.
50
The MAC CS platform, developed by Duettmann, facilitates
vital sign, health status, and medication intake uploads by transplant recipients via a smartphone app. The app then directly
transmits this information to databases and electronic health records, which are subsequently used for routine patient care
through medical messages or video consultations. Additionally, doctors can securely transmit updated medication plans and
lab data through the platform.
51
The KTx360 study by Schiffer et al is a multi-center, multi-department, multi-modality
telemedicine-based follow-up care model that enhances patient and graft survival, minimizes avoidable hospitalizations and
comorbidities, lowers healthcare costs, and improves the quality of life of renal transplant recipients. This is achieved through
the introduction of e-health elements and comprehensive treatment options for recipient management.
52
The rise of wearable
technology, sensing technology, mobile information, and other technologies is changing the existing methods of medication
for patients and providing technical support to enhance medication compliance. Face recognition technology, smart pills,
smart medicine bottles, smart pill boxes, and personal assistant reminders are utilized in the patient’s medication. Meanwhile,
investigator van Lint from the Netherlands examined the adherence level of renal transplant patients to the creatinine
monitoring program and assessed the reliability of creatinine values recorded in the web-based self-management support
system (SMSS).
53
The advancement in immunosuppressant testing equipment technology has made it possible to remotely
detect drug concentration. Emerging sampling methods, such as Dried Blood Spot (DBS) and quantitative absorptive
microsamplers (VAMS), have been developed.
54,55
In the future, it is necessary to further explore the hospital needs of
transplant recipients using telemedicine, learn from the transplant recipient self-management model based on telemedicine,
evaluate its economic costs and benets, and improve the quality of medical services launch a comprehensive and scientic
self-management program for renal transplant recipients. Forthcoming years, the implementation of telemedicine will
necessitate collaborative efforts from government regulators, infrastructure developers, and insurance providers to enhance
the well-being of a greater number of transplant patients.
Strengthen the Whole Life Cycle Follow-Up Management and Make the Best
Transition Plan
After renal transplant patients are discharged from hospital, Follow-up after kidney transplantation is essential for the long-
term survival of the recipient and the graft. In this study, it is found that in keyword clustering and burst words, the population
of self-management of renal transplantation covers children, young adult, middle aged, aged. Follow-up after renal trans-
plantation is very important for the long-term survival of recipients and transplanted organs. To improve the self-management
ability of renal transplant recipients, medical staff should actively carry out long-term and effective communication and
follow-up.
56
Children and adolescents are at high risk of poor medication compliance and discontinuation of follow-up, which
can lead to a poorer prognosis. Adolescence and young adulthood are particularly high-risk periods as increased immune
activity, combined with poor compliance with immunosuppressive drugs, increases the risk of premature graft loss.
57
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Although there are currently no programs specically designed for kidney transplant recipients, further research is needed to
determine the most effective way to provide transitional care.
58
Developing a child-adolescent-young adult care transition plan
and strengthening the life cycle follow-up management of renal transplant recipients is necessary. Research on care transition
for kidney transplantation in younger patients should focus on designing intervention measures with increased patient
participation and educational theory to formulate personalized and professional transitional care plans suitable for children
and adolescents.
59,60
Few studies involve evidence-based educational methods or theories. At the same time, for young and
middle-aged renal transplant patients, early psychosocial adaptability should also be paid attention to. Some studies have
shown that the early psychosocial adaptation level of young and middle-aged renal transplant patients is negative. The medical
team should pay attention to the social and psychological adaptation of young and middle-aged kidney transplant patients in
the early stage after kidney transplantation, especially in the early stage (< 1 year after surgery), and help patients establish
positive disease cognition shortly after kidney transplantation. At the same time, psychological care and support are also
provided to help early renal transplant recipients successfully adapt to the changes after transplantation, rebuild their social
roles, return to work or school as soon as possible, and improve their psychosocial adaptation. By contrast, Senile renal
transplantation has been paid more and more attention by both doctors and patients. Because of its older age, long medical
history and various complications, the reserve function of each organ tends to decline obviously. The implementation of
professional, standardized, persistent, personalized and procedural follow-up management for renal transplant recipients is of
great signicance for graft survival time and prevention of complications. Therefore, when designing research plans in the
future, it is necessary to increase patient participation and combine educational theory to formulate personalized and
professional transitional care plans suitable for kidney transplant recipients throughout the life cycle.
Kidney Transplantation Health Literacy and Self-Management
Health literacy means acquiring a certain degree of knowledge, personal skill sand condence in taking action to improve
personal and community health by changing individual life styles and living conditions.
61
The lack of treatment
compliance caused by lack of understanding of medical information related to modied drug therapy after organ
transplantation or inability to search for appropriate information about lifestyle correction or support system will increase
the possibility of re-hospitalization and transplant organ failure.
61
Health literacy has recently received attention as a key
factor in treatment compliance and health-related quality of life, which can improve patients’ understanding of their own
health and their ability to follow treatments provided by health professionals after organ transplantation.
62
Studies have
shown that patients’ health literacy should be evaluated before transplantation to determine the treatment non-compliance
of potentially high-risk patients.
63
A prospective cohort study of renal transplant health literacy and self-management
once again demonstrated the importance of self-management of renal transplantation, and the knowledge and under-
standing of renal transplant-related complications and the management of these complications are changeable factors,
especially in the rst six months after renal transplantation. In view of this, we believe that it is necessary to study health
literacy and self-management during pre-transplant inspection. Future research should investigate not only post-
transplant patients, but also dialysis and pre-dialysis patients. Researchers should start with kidney disease to better
understand the importance and relationship between health literacy and self-management, as well as to obtain transplant
and clinical outcomes at all stages of kidney disease. Health care professionals need to know those who need more
support in learning post-transplant lifestyles and drug treatments. Therefore, this requires close cooperation within
multidisciplinary teams, who need self-management support interventions to achieve improvement. We focus on the post-
transplantation period, but it may be more effective to start self-management support before migration. After transplanta-
tion, intervention measures for patients should be formulated and self-management should be provided to reect the level
of health literacy of patients and ultimately improve the prognosis of patients.
6
To improve the literacy of health
management and compliance with treatment, it is necessary to increase patients’ sense of responsibility for their health
maintenance and management and include them in the decision-making of treatment process and health management.
63
In the future, medical staff can set up a feedback reward system to gradually guide patients to understand the benets
brought by changes in their self-behavior, and to establish or restore their sense of self-efcacy, so as to promote the
production and maintenance of healthy lines by patients. Guiding patients to formulate a commitment agreement on
rehabilitation plans can assist patients to strengthen self-restraint and help patients to fully understand their own diseases
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and specic measures of health behavior. Through functions such as self-discipline, peer inuence, and emotional
feedback, it encourages patients with chronic diseases to nd their own ways of self-management, thereby improving
their health behaviors.
Conclusion
At present, the research hotspots of self-management of kidney transplant recipients tend to focus on medication
compliance, psychological evaluation of kidney transplant patients, quality of life, health literacy and other aspects. To
advance the research and development of self-management for renal transplant recipients, it is crucial to leverage the
benets of interdisciplinary collaboration and resource complementarity. In the future, it is necessary to improve the
cognitive level of renal transplant recipients, pay attention to patient empowerment, and apply the technologies of
telemedicine, Internet of things, big data, wearable equipment and immunosuppressant testing equipment to the self-
management of renal transplant recipients. Broaden the channels of health information for renal transplant recipients,
improve drug compliance and self-management, reduce related complications, and further improve quality of life. At the
same time, improve the existing follow-up management system and strengthen the life cycle follow-up management of
renal transplant recipients.
Data Sharing Statement
All data generated or analyzed during this study are included in this published article.
Funding
This study was supported by the Clinical nursing research project of Zhongnan Hospital of Wuhan University
(LCHLYJ202310).
Disclosure
All of the authors had no any personal, nancial, commercial, or academic conicts of interest separately.
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