Kidney transplantation

Living transplant-recipients

Qualification

Kidney Transplantation Criteria

  1. The uremia patients who are under dialysis treatments and qualified to be catastrophic illness patients (exception: living-donor transplant).
  2. Excepting the kidney diseases that the patients have carried, the patients do not have other severe illness, such as cancer and active infection.
  3. The patients want to have kidney transplants at their own free wills, and can fully understand the rate of successes, dangers and complications.
  4. The bladders and urinary tracts of the patients perform their normal functions. If not, the patients need to have corresponding treatments.

Most end stage kidney failure (uremia) patients depend on dialysis. They are suitable for kidney transplant unless the patient has other
contraindications, such as malignant tumor, whole body infection, severe cardiovascular diseases, unstable coagulation, chronic respiratory failure, cardiac failure, mental illness, severe congenital malformations of urinary system and aids.

Kidney transplant waiting flowchart and its benefits

Fee

Taiwanese and residents：
Taiwanese and residents please refer r to the standard charge of outpatient clinic and emergency service.

Foreigners：
Foreigners who do not have the national health insurance will be charged by international medical standard fee.

1、Clinic/emergency：

  1. Registration: NTD $500
  2. Examination fee: NTD $1500
  3. Special service fee (you will have a coordinator helping atsite): NTD $200 per visit
  4. Psychiatric consultation: NTD $2,500
  5. You may be charged by other medicine tests and treatments

2、Stay in hospital：

  1. Inpatient examination and nursing fee: three times the price of the national health insurance standard charge
  2. General service fee: NTD $5,000 per stay
  3. NHI covered services/treatments: 2.21 times the price of the national health insurance standard charge
  4. Self-paid services/treatments: 1.7 times the price of the self-pay standard charge from department of health, Taipei city government. .

Depending on the treatments, we will estimate the medical cost. You will need to pay the deposit before staying in the hospital. The patient will only pay for the service and treatments they use (the hospital will return the rest of the money)

Payment options（IMSC）

  • Exchanging new Taiwanese dollar
  • Credit card (VISA card, Master card and china unionpay card)
  • Transfer

Clinic/inpatient arrangement

The assessments before kidney transplant is very important. The main purpose is to reduce the complications after the surgery. We will arrange you to have the following examinations:

  1. Blood test：
    Blood type, functions of liver and kidney, anti-HAV, anti-HBV, antiHCV, the virus quantity of hepatitis BC (self-paid), antibody of     syphilis, AIDS, tumor index, blood counting, hemostasis, thyroid function, tuberculosis (self-pay), tissue matching and autoimmune system.

  2. Image check: chest x ray and abdominal ultrasound.

  3. Female: Breast ultrasound and mammography.

  4. Other: Electrocardiography and urinalysis and urine cytology.

If patients are also elders or having diabetes, they need to take further cardiac examinations, such as cardiac ultrasound or systolic function. Elder women need to take breast and cervix examinations. Elder men need to take prostate examinations and bladder function examinations if having difficulty of urination. Oral health is also important. If you have cavities, you need to take treatment immediately. Otherwise, they may become the cause of transplant infection.

Treatments before ABO-incompatible kidney transplantation

  1. Reducing the remaining blood type antibody: plasmapheresis and giving IVIG.
  2. Reducing: the active of B cell: giving rituximab 375 mg/m2 ~3 weeks before the surgery.
  3. Reducing: the active of T cell: giving acrolimus, mycophenolate , Mofetil, pre-transplant basiliximab (optional), and proper antibiotics to prevent infection.

After these medicine treatments, according to the researches, ABO- ncompatible kidney transplantation can lead to the similar results as ABO-compatible cases, including survival of the patient and transplant liver, the function of the liver, the rejection and infection. However, for those whose blood type antibody rate is higher than 1:512, the rate of biopsy-proven allograft rejection is still higher than ABO-compatible transplant. Therefore, the patient whose blood type antibody is higher needs to take the medicine and follow up more carefully to have the best result For more information, please leave your information on “ contact us.” We will reach you back once receiving your information.

Treatments

The surgery will be performed in the lower quadrant of the abdomen. The doctor will make an incision that looks like new moon. Then, the doctor will place the kidney at the pelvic fossa, and match the arteries and veins of the kidney and proximal ureter.

Nursing care plans

  1. If there are not any rejections or complications, the patient may be discharged 10~14 days after the surgery.
  2. Long-term medications is necessary after the surgery (including anti-rejection medicines and other medicines in need). Each medicine has certain side effects (see 9. below).
  3. Blood transfusion–kidney failure often happens with anemia. Therefore, in order to maintain cardiopulmonary function, sometimes it is necessary to have blood transfusion during the surgery. The side effect of blood transfusion is showed in the blood transfusion consent form. If you disagree with blood transfusion, please inform the medical crew in advance.
  4. Acute rejection (10-20%)–most of the acute rejections can be treated by the stronger anti-rejection medicines. Only in some rare cases (<5%), the acute rejections cause the permanent transplanted kidney function failure.
  5. Sometimes the transplanted kidney will not fully function after the surgery. The incidence depends on the resources of the transplanted kidney; <10% for living-donor transplants and 30% for deceased-donor transplants.
  6. Hematuria might happen at different levels to the patients after the surgery. In general, this symptom will be self-improved.
  7. The incidence of complications after the surgery is 5%-10%. With severe complications, the patient may need to have another surgery.
    ⓵ Infection or slowing healing of wounds-the wounds may have some complications due to anti-rejection medicines.
    ② Wound bleeding
    ③ Urinary incontinence
    ④ Hernia of the incision
    ⑤ Embolism of kidney artery or kidney vain-needing to have another surgery, or blood vessel aggressive treatment.
    ⑥ Infection-such as urinary tract infection, infection of respiratory tract, other virus infections and severe systemic infections.
    ⑦ Malignant tumors, such as lymphoma or other solid cancer (including relapse of the diseases).
    ⑧ The transplanted kidney not functioning.
    ⑨ Cardiac or vascular diseases.
    ⑩ New onset diabetes.
  8. Death (<1%)
  9. The kidney diseases that the donor had carried may occur to the transplanted kidney.
  10. The side effects of certain anti-rejection medicines:
    ⓵ Cyclosporine (Neural) or tacrolimus (Prograf): tremor, high blood pressure, kidney function declining, constipation, diarrhea, headache, abdominal pain, sleep disorder, hypophosphatemia, hypomagnesaemia, gum thickening, hair growing, baldness, hyperkalemia and diabetes.
    ② Prednisolon: appetite increasing, body weight gaining, appearance changing (moon face and buffalo hump), body fluid detaining, high blood pressure, impaired sugar tolerance, bone density decreasing (more risky having fractures), digestive disorder, cataract, glaucoma, skin thinner, easy having bruises.
    ③ Mycophenolate mofetil (Cellcept )or Mycophenolic Acid (Myfortic):
    leukocyte and platelets decreasing at different levels, nausea, vomiting, diarrhea, fever throat pain, tiredness, muscle pain, tuberculosis, hepatotoxic, pancreatitis.
    ④ Sirolimus (rapamune) and everolimus (certican): leukocyte and platelets decreasing at different levels, canker sores, diarrhea, edema or pain in lower limbs, rash and hepatotoxic.
    ⑤ 新睦樂（Basiliximab，Simulect）、（第二介白質接受器的”抗體”）：副作用相當不常見、偶有輕微肝指數上升。這些症狀在減低藥物劑量後會改善，有些則無法改善。

Applying for medical records/certificate of dianosis

The duration and procedure of applying for medical records

1、Applying options

  1. 「Online」。
  2. Counter service
  3. Applying online (taking about 2~7 business days) willsave your time instead of waiting in the hospital. However, when pick up the copies, you need to bring your id to the counter and pay.
  4. You can directly apply at the medical counter without registration or seeing a doctor.
  5. When applying for your copies, please tell us the term, the services/treatments and the duration of your record. If you do not know how to find the information, you may ask your doctors for help when visiting them.
  6. You need to pick your copies within 1 month after informed. If you do not do so, you will need to reapply.
  7. For videos or images copies, please apply at the image counter 8 of radiation department on the 8 th floor in the Zhongzheng building.

2、Procedure

  1. Please bring your ID and related documents, take a number at the counter and wait your turn.
  2. Fill out the application form.
  3. The staff will verify you application.
  4. Pay and collect your copies.
  5. For the requirements of applicant and enclosed documents, please refer to Here 

The duration and procedure of applying for certificates of diagnosis

  1. The patient applies for certificates of diagnosis while staying in hospital will need to prepare the draft made by your doctor. Then, bring it to division of medical affairs admission (the inpatient counter on 1st floor in the Zhongzheng building) for an official copy.
  2. Chinese copy：NTD $100 for the first copy；NTD$50 for the second and more copies English copy：NTD $200 for each copy.
  3. Outpatients who needs to apply for the certificates of diagnosis please refer to Here
  4. For reissuing certificates of diagnosis (same copy from the one you have applied before), you need to provide your identification (as the list below) and an application. (Download：(application）
  5. For the requirements of applicants and enclosed documents please refer to Here

Revisits/follow-ups

After discharged from hospital, you need to visit your doctor to follow up your conditiond once a week in the beginning. After stabilizing, you may visit the doctor once every 2 weeks or a month. During the visits, you will need to take blood tests to measure the kidney function and the amount of the anti-rejection medicines in the blood.