Evaluation of patients with lymphocele after renal transplantation

  • Ali Sapmaz Department of Surgery, Bilkent City Hospital, Ankara, Turkey
  • Ramazan Kozan Department of Surgery, School of Medicine, Gazi University, Ankara, Turkey
  • Murat Özgür Kılıç Department of Surgical Oncology, Eskisehir City Hospital, Eskisehir, Turkey
  • Aydın Dalgıç Department of Surgery, School of Medicine, Gazi University, Ankara, Turkey
  • Hakan Sözen Department of Surgery, School of Medicine, Gazi University, Ankara, Turkey
Keywords: diagnosis; lymphocele; renal transplantation; treatment

Abstract

Introduction: The lymphocele is a common complication following renal transplantation and may cause significant clinical problems especially when reachs to big volumes. The aim of this study is to present the clinical characteristics, diagnostic approaches, and therapeutic strategies of lymphocele formations in a group of Turkish patients. Methods: A total of 244 renal transplantations were included in this retrospective study. Data of patients who were diagnosed with lymphocele during the postoperative period were analyzed. Results: Ten (2.4%) patients have been diagnosed with lymphocele. There were six males and 4 females, with a mean age of 46 years. The median onset was 19 days posttransplantation. The median size of the lymphoceles was 53 mm. All lymphoceles were localizated between the lower pole of the transplanted kidney and urine bladder. On presentation, one patient had hydronephrosis and three patients had elevated serum creatinine while the remaining six ones were asymptomatic. Five patients were successfully treated by percutaneous aspiration whereas two patients required surgery. Three patients’ lymphoceles dissolved spontaneously. Conclusion: Preventive strategies including preserving the lymphatics of the recipient, careful organ retrieval and ‘back table’ work are of great importance to reduce the incidence of lymphocele. Early decision of radiological or surgical intervention should be considered in patients with symptomatic lymphoceles in order to prevent further complications.

References

1) Atray NK, Moore F, Zaman F, Caldito G, Abreo K, Maley W, et al. Post transplant lymphocele: a single centre experience. Clin Transplant. 2004;18(Suppl. 12):46-9.

2) Adani GL, Baccarani U, Bresadola V, Lorenzin D, Montanaro D, Risaliti A, et al. Graft loss due to percutaneous sclerotherapy of a lymphocele using acetic acid after renal transplantation. Cardiovasc Intervent Radiol. 2005;28(6):836-8.

3) Zietek Z, Sulikowski T, Tejchman K, Sieńko J, Janeczek M, Iwan-Zietek I, et al. Lymphocele after kidney transplantation. Transplant Proc. 2007;39(9):2744-7.

4) Sözen, H., Fidan, K., Onaran, M, Arinsoy T, Dalgiç A. Outcome of the using older donors for kidney transplantation. Transplant Proc. 2010;42(7):2477-8.

5) Hamza A, Fischer K, Koch E, Wicht A, Zacharias M, Loertzer H, et al. Diagnostics and therapy of lymphoceles after kidney transplantation. Transplant Proc. 2006;38(3):701-6.

6) Smyth GP, Beitz G, Eng MP, Gibbons N, Hickey DP, Little DM. Long-term outcome of cadaveric renal transplant after treatment of symptomatic lymphocele. J Urol. 2006;176(3):1069-72.

7) Ebadzadeh MR, Tavakkoli M. Lymphocele after kidney transplantation: where are we standing now? Urol J. 2008;5(3):144-8.

8) Singh AG, Jai SJ, Ganpule AP, VijayKumar M, Sabnis RB, Desai MR. Critical appraisal of consecutive 36 cases of post renal transplant lymphocele: a proposed algorithm. World J Urol. 2017;35(9):1443-50.

9) Bzoma B, Kostro J, Dębska-Ślizień A, Hellmann AR, Zadrożny D, Śledziński Z, et al. Treatment of the Lymphocele after kidney transplantation: a single-center experience. Transplant Proc. 2016;48(5):1637-40.

10) Heer MK, Clark D, Trevillian PR, Sprott P, Palazzi K, Hibberd AD. Functional significance and risk factors for lymphocele formation after renal transplantation. ANZ J Surg. 2018;88(6):597-602.

11) Joosten M, d'Ancona FC, van der Meijden WA, Poyck PP. Predictors of symptomatic lymphocele after kidney transplantation. Int Urol Nephrol. 2019;51(12):2161-7.

12) Martínez-Ocaña JC, Lauzurica R, Castellote E, Bonet J, Tenesa M, Jiménez JA, et al. Adult polycystic kidney disease: a risk factor for lymphocele formation after renal transplantation? Transplant Proc. 1995;27(4):2246-7.

13) Choudhrie AV, Kumar S, Gnanaraj L, Devasia A, Chacko N, Kekre NS. Symptomatic lymphocoeles post renal transplant. Saudi J Kidney Dis Transpl. 2012;23(6):1162-8.

14) Zagdoun E, Ficheux M, Lobbedez T. Complicated lymphoceles after kidney transplantation. Transplant Proc. 2010;42(10):4322-5.

15) Goel M, Flechner SM, Zhou L, Mastroianni B, Savas K, Derweesh I, et al. The influence of various maintenance immunosuppressive drugs on lymphocele formation and treatment after kidney transplantation. J Urol. 2004;171(5):1788-92.

16) Ranghino A, Segoloni GP, Lasaponara F, Biancone L. Lymphatic disorders after renal transplantation: new insights for an old complication. Clin Kidney J. 2015;8(5):615-22.

17) Gray DWR. Vascular and lymphatic complications after renal transplantation. En: Morris PJ, ed. Kidney transplantation, principles and practice. 5th ed. Philadelphia: WB Saunders; 2001, p. 424-6.

18) Khauli RB, Stoff JS, Lovewell T, Ghavamian R, Baker S. Post-transplant lymphoceles: a critical look into the risk factors, pathophysiology and management. J Urol. 1993;150(1):22-6.

19) Iwan-Zietek I, Zietek Z, Sulikowski T, Nowacki M, Zair L, Romanowski M, et al. Minimally invasive methods for the treatment of lymphocele after kidney transplantation. Transplant Proc. 2009;41(8):3073-6.

20) Lucewicz A, Wong G, Lam VW, Hawthorne WJ, Allen R, Craig JC, et al. Management of primary symptomatic lymphocele after kidney transplantation: a systematic review. Transplantation. 2011;92(6):663-73.
Published
2020-09-16
How to Cite
1.
Sapmaz A, Kozan R, Özgür Kılıç M, Dalgıç A, Sözen H. Evaluation of patients with lymphocele after renal transplantation. Rev Nefrol Dial Traspl. [Internet]. 2020Sep.16 [cited 2024Dec.21];40(3):194-9. Available from: http://revistarenal.org.ar/index.php/rndt/article/view/532
Section
Original Article