Symptomatic lymphoceles after kidney transplantation – multivariate analysis of risk factors and outcome after laparoscopic fenestration

Abstract

Lymphocele formation is a common complication after kidney transplantation, and laparoscopic surgery has become a widely accepted treatment option. The aim of this retrospective study was to analyze the risk factors of lymphocele development and to assess the treatment outcome after laparoscopic fenestration. We analyzed 426 renal allograft recipients operated between 2002 and 2006 receiving triple immunosuppression with calcineurin inhibitors. The incidence of lymphocele was 9.9%, while 24 (5.6%) patients with symptomatic lymphoceles required laparoscopic surgery. Serum creatinine at diagnosis was significantly higher in patients with lymphoceles treated surgically (3.2 +/- 0.7 vs. 1.7 +/- 0.6 mg/dL; p < 0.001). After successful laparoscopic intervention, creatinine concentrations recovered until discharge and were comparable to other patients (1.6 +/- 0.5 vs. 1.5 +/- 0.5 mg/dL; p = NS). While we observed a significant association of lymphocele formation with diabetes, tacrolimus therapy, and acute rejection in univariate testing, only diabetes remained a significant factor after multivariate analysis. Laparoscopic fenestration proved to be a safe and efficient method without any associated mortality and a low recurrence rate of 8.3% (n = 2). We conclude that diabetes is an independent risk factor for lymphocele development, and laparoscopic fenestration should be the treatment of choice for larger and symptomatic lymphoceles, as it is safe and offers a low recurrence rate.

Renal Relevant Radiology

“…Clinical presentation signs are usually pain over the graft, swelling, or change in graft function. Lymphatic leakage can be caused by disrupting lymphatic channels during the preparation of the recipient iliac vessels or by the graft itself (21). A high percentage of lymphoceles are diagnosed incidentally because most perirenal lymphatic collections are small and asymptomatic.…”

Effect of Donor Nephrectomy Technique on Recipient Lymphatic Drainage

“…Similarly, Lipay et al [15] described 84% of !1 acute rejection episode of patients with lymphocele. However, Ulrich et al [16], in a cohort of 426 renal allograft recipients, noted association between rejection, diabetes, and tacrolimus therapy on univariate analysis, but found only diabetes to be associated on multivariate analyses. They concluded diabetes was an independent risk factor for lymphocele development [16].…”

Laparoscopic Fenestration of Posttransplant Lymphoceles: A Report of Three Cases

“…Symptoms that suggest lymphoceles are pain in the area of the pelvis or abdomen, caused by a pelvic mass that can be seen or palpated. Other side effects include, outcomes of venous or ureteral pressure, such as one-sided leg oedema and leg torment, hydronephrosis with resulting insufficiency of renal capacity, and profound vein thrombosis [10]. Fever and leucocytosis are indicative of infectious complications of lymphatic fluid accumulation.…”