Percutaneous Aspiration and Drainage of Fluid Collections Complicating Solid Organ Transplants

Abstract

A number of different types of fluid collections complicate renal, hepatic, and pancreatic transplantation. These collections can be the source of considerable morbidity and even death for the transplant recipient and, depending on the location of the collection, can also be responsible for graft dysfunction. This paper reviews the impact of percutaneous aspiration and drainage on the management of transplant-related fluid collections. Little in the literature addresses this topic specifically; consequently, the material presented here most often reflects data culled from larger general reports on the complications of organ transplantation. IMAGING AND PROCEDURAL TECHNIQUESDetection of peritransplant or other abdominal fluid collections after transplantation is usually accomplished with sonography (US) or computed tomography (CT). A particular advantage of US over CT in the setting of perivascular collections is its Doppler capability, which permits a noninvasive determination of intramass flow and, therefore, the inclusion or exclusion of the diagnosis of pseudoaneurysm.Although much has been written on the characterization of fluid collections, such as lymphoceles, hematomas, abscesses, urinomas, bilomas, and pseudocysts, by US or CT features alone, definitive diagnosis of such collections requires the acquisition of fluid for laboratory and microbial analysis. Often, this fluid is obtained by percutaneous needle aspiration. Much of the ambiguous nature of papers addressing post-transplantation complications relates to the fact that fluid collections are not definitively characterized before the analysis of the clinical data. On the other hand, fluid collections may be rather specifically characterized by fluoroscopy when leakage is defined by a catheter study with contrast injection. In this manner, urinomas, bilomas, and leaks from pancreatic ducts or duodenocystosomies can be diagnosed directly, although obviously, the presence of superimposed infection cannot be determined.Similarly, imaging guidance for percutaneous aspiration and drainage procedures in these settings is typically accomplished with US or CT. 1-7 In many instances, US guidance alone is adequate, although in some patients, particularly hepatic or intraperitoneal pancreatic recipients, at least a preliminary diagnostic CT examination with gastrointestinal opacification is useful to exclude the presence of multiple collections and to localize bowel loops that may make catheter course planning difficult. Additionally, when the location of a target collection in relation to adjacent bowel loops or vascular structures is uncertain, CT with intestinal opacification, and occasionally with intravenous enhancement, is necessary. Fluoroscopic guidance for percutaneous procedures can be used when adequate contrast opacification of a collection is seen after a diagnostic catheter study; when fluoroscopic guidance is utilized, use of a rotational C-arm aids in determining the three-dimensional anatomic relations of the fluid collection to nearby structur...