Extended Abstract
Introduction
Currently, the prevalence of chronic kidney disease has increased for a variety of reasons. Renal diseases, followed by dialysis and kidney transplantation, can greatly affect people’s physical and mental health. Previous studies have reported psychological problems in patients with kidney disease after transplantation, including depression, anxiety, hopelessness, lack of control over living conditions, and tiredness [15, 16]. The present study aimed to investigate the psychological challenges of renal disease patients after kidney transplantation. By knowing the experiences of these patients after transplant surgery, we can understand what psychological and social conditions they experience.
Materials and Methods
This is a descriptive study. The study population consisted of kidney transplant patients aged 35-50 years referred to the Nephrology Clinic of Labafinejad Hospital in Tehran, Iran in 2019 and 1-5 years had passed since their transplantation. A purposive sampling was used and continued until data saturation and until no themes were available. In the end, 15 patients were selected and underwent a semi-structured in-depth interview. Prior to the interview, patients were explained about the research and the method of implementation. Then, their demographic characteristics were recorded. Questions focused on patients’ experiences of postoperative psychological challenges. The questions were: 1= How were the psychological experiences you had after the transplantation? And 2= How is your experience of life again after kidney transplantation? Data analysis was performed by seven-step method of Colaizzi [18, 19]. In order to achieve the validity and reliability of the study, credibility and trustworthiness criteria were measured according to Lincoln and Guba’s method [20].
Results
The primary themes were divided in to 3 main themes including: 1= Concerns and psychologically disturbing feelings, 2= emotional and spiritual support by the family, and 3= uncertainty of receiving specialized, financial and welfare support. The first main theme obtained from 13 initial codes including numbness/ pain/fatigue/tiredness, infection and fever, skin allergies and swelling, reduced activity and overweight, observing health issues about the self and in relation with others, stress and fear of transplant failure, anxiety and stress, nutritional care and worries, decreased patience and being nervous, obsession and depression, feeling lonely and isolated, failure to observe the physical and mental conditions of the patient by the people around and pity too much, people’s curiosity and questioning about the transplant. The second main theme was obtained from 3 codes including interaction with partner/family members/relatives after transplantation, having desire to communicate more with others, and financial and moral support. Finally, the last main theme was derived from 5 codes which were: high costs of medication and transplant surgery, fears of lack of timely access to medications, commuting costs, work-related problems, and concerns about future and family (Table 1 & 2). 

Discussion
Results showed that three main experiences of patients after kidney transplantation are: Concerns and psychologically disturbing feelings, emotional and spiritual support by the family, and uncertainty of receiving specialized, financial and welfare support. Our result is consistent with the results od Mohammadi Dastja et al. In their study, they showed that patients after transplantation experience high levels of anxiety about graft rejection and are under high stress [22]. Ghogazardi and Safari by a epidemiologic study of psychiatric disorders in renal transplant patients, reported that obsessive-compulsive disorder and high anxiety are the mental disorders in transplant patients [23]. These patients are not in the mood to listen to those around them, and are plagued with obsessive-compulsive thoughts/actions and depression. They experience loneliness and when compare their current life with pre-transplant life and see their activity has reduced they become depressed [15]. Suzuki et al. also found out that these patients experience a high level of depression [25]. Rayyani et al. showed that matching facilitators in kidney transplant recipients include 3 internal and external sources. External resources included main themes that were divided into four categories: family, peers, care system, and social organizations [26]. In Mendonça et al.’s study, the biggest changes in the quality of life of patients after kidney transplantation were identified in social relations domains [27]. After transplantation, they feel more isolated than before. Studying these challenges can provide a deeper understanding of the psychological problems of kidney transplant patients and their postoperative adaptation.

Ethical Considerations
Compliance with ethical guidelines
This study with a code IR.IAU.SRE.1398.022 was approved by the Research Ethics Committee at Islamic Azad University, Science and Research Branch in Tehran, Iran.
Funding
This study was extracted from the master thesis of the first author, Homa Yosefi, approved by the Department of Counseling and Guidance, Faculty of Humanities and Social Sciences, Islamic Azad University, Science and Research Branch .

Authors' contributions
All authors met the writing standards based on the recommendations of the International Committee of Medical Journal Editors (ICMJE).
Conflicts of interest
The authors declare no conflict of interest.
Acknowledgements
The authors would like to thank the staff of Labafinejad Hospital in Tehran and all patients for their support and cooperation.