Lymphocele after pediatric kidney transplantation: Incidence and risk factors

Abstract

Lymphocele is a well-known postoperative complication after kidney transplantation. The aim of this study was to analyze time trend incidence, risk factors, and outcome of post-transplant lymphocele in a large pediatric cohort. This is a retrospective single institution review of 241 pediatric kidney transplants performed from 2000 to 2013. Etiology of end-stage renal disease, recipient age and gender, transplant year, BMI percentile for age, type of dialysis, living/non-living related donor, acute rejection, and multiple transplantations were analyzed in association with lymphocele formation. Fourteen of 241 (5.81%) children developed a postoperative lymphocele. There has been a reduction in the incidence of lymphocele after 2006 (3.22% vs. 8.55%, p < 0.05). Significant risk factors for lymphocele were older age (≥11 yr), transplant before 2006, male gender, BMI percentile for age ≥95%, and multiple transplantations (p < 0.05). The one-yr graft survival was significantly reduced in the group with lymphocele compared with control (81.2% vs. 92.51%, p < 0.04). This is the first pediatric report showing the following risk factors associated with post-transplant lymphocele: age ≥11 yr, male gender, BMI for age ≥95%, and multiple transplantations. A lymphocele can contribute to graft loss in the first-year post-transplant.

Assessment of perioperative surgical complications in pediatric kidney transplantation: A comparison of pre‐emptive and post‐dialysis recipients

“…However, it is difficult to discern lymphoceles that do not require intervention from those that do in some studies, making a direct comparison difficult. Nonetheless, our cohort displayed similar rates of lymphoceles as previously reported . Other risk factors such as immunosuppression regimens including mycophenolate mofetil have also been described as potential risk factors for lymphocele formation.…”

“…Nonetheless, our cohort displayed similar rates of lymphoceles as previously reported. [11][12][13][14] Other risk factors such as immunosuppression regimens including mycophenolate mofetil have also been described as potential risk factors for lymphocele formation. This investigation was unable to assess this potential confounder; however, the immunosuppression regimen has not significantly changed over the study period and the sensitivity analysis of time periods do not reveal potential differences based on evolution of perioperative care within the study period.…”

“…Our study objectives do not specifically aim to identify risk factors for lymphocele formation, and hence, it is difficult to ascertain a definite relationship between sex and lymphocele formation. However, as both are retrospective studies with relatively small sample size and event rate (5.81% in Giuliani et al12 ), a larger prospective study would be necessary to investigate this relationship further. The trend in ESRD etiology is also observed in the pre-emptive and post-dialysis DD groups, although not statistically significant.…”

Doxycycline sclerotherapy for post-traumatic inguinal lymphocele in a child

“…This is theorised to be due to limited and more accurate retroperitoneal dissection. One retrospective review identified older age, transplant prior to 2006, male gender and body mass index >95% as independent risk factors for developing a post-transplant lymphocele, which was found to reduce 1-year graft survival by 10% 6. There is no consensus on the best treatment, but typically patients undergo aspiration with or without sclerotherapy and rarely surgical intervention.…”

Untitled

“…Patients are usually asymptomatic, and spontaneous resolution occurs after a few months. [32][33][34][35][36] The incidence of symptomatic lymphoceles after kidney transplant in our center has been 4.2% (109/2594 total cases). This complication presented with elevated serum creatinine levels in 31 patients (28.4%), pain and abdominopelvic swelling in 53 patients (48.6%), and lower extremity edema in 25 patients (22.9%).…”