Post-Transplant Lymphoceles: A Critical Look into the Risk Factors, Pathophysiology and Management

Abstract

No AccessJournal of Urology1 Jul 1993Post-Transplant Lymphoceles: A Critical Look into the Risk Factors, Pathophysiology and Management Raja B. Khauli, Jeffrey S. Stoff, Tammy Lovewell, Reza Ghavamian, and Stephen Baker Raja B. KhauliRaja B. Khauli More articles by this author , Jeffrey S. StoffJeffrey S. Stoff More articles by this author , Tammy LovewellTammy Lovewell More articles by this author , Reza GhavamianReza Ghavamian More articles by this author , and Stephen BakerStephen Baker More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)35387-9AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail To define better the prevalence and pathophysiology of lymphoceles following renal transplantation, we prospectively evaluated 118 consecutive renal transplants performed in 115 patients (96 cadaveric, 22 living-related, 7 secondary and 111 primary). Ultrasonography was performed postoperatively and during rehospitalizations or whenever complications occurred. Perirenal fluid collections were identified in 43 patients (36%). Lymphoceles with a diameter of 5cm. or greater were identified in 26 of 118 cases (22%). Eight patients (6.8%) had symptomatic lymphoceles requiring therapy. The interval for development of symptomatic lymphoceles was 1 week to 3.7 years (median 10 months). Risk factors for the development of lymphoceles were examined by univariate and multivariate analysis, and included patient age, sex, source of transplants (cadaver versus living-related donor), retransplantation, tissue match (HLA-B/DR), type of preservation, arterial anastomosis, occurrence of acute tubular necrosis-delayed graft function, occurrence of rejection, and use of high dose corticosteroids. Univariate analysis showed a significant risk for the development of lymphoceles in transplants with acute tubular necrosis-delayed graft function (odds ratio 4.5, p = 0.004), rejection (odds ratio 25.1, p <0.001) and high dose steroids (odds ratio 16.4, p <0.001). When applying multivariate analyses using stepwise logistic regression, only rejection was associated with a significant risk for lymphoceles (symptomatic lymphoceles—odds ratio 25.08, p = 0.0003, all lymphoceles—odds ratio 75.24, p <0.0001). When adjusting for rejection, no other risk factor came close to being significant (least p = 0.4). Therapy included laparoscopic peritoneal marsupialization and drainage in 1 patient, incisional peritoneal drainage in 4 and percutaneous external drainage in 3 (infected). All symptomatic lymphoceles were successfully treated without sequelae to grafts or patients. We conclude that allograft rejection is the most significant factor contributing to the development of lymphoceles. Therapy of symptomatic lymphoceles should be individualized according to the presence or absence of infection. © 1993 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited BySmyth G, Beitz G, Eng M, Gibbons N, Hickey D and Little D (2018) Long-Term Outcome of Cadaveric Renal Transplant After Treatment of Symptomatic LymphoceleJournal of Urology, VOL. 176, NO. 3, (1069-1072), Online publication date: 1-Sep-2006.GOEL M, FLECHNER S, ZHOU L, MASTROIANNI B, SAVAS K, DERWEESH I, PATEL P, MODLIN C, GOLDFARB D and NOVICK A (2018) The Influence of Various Maintenance Immunosuppressive Drugs on Lymphocele Formation and Treatment After Kidney TransplantationJournal of Urology, VOL. 171, NO. 5, (1788-1792), Online publication date: 1-May-2004.CHIN A, RAGAVENDRA N, HILBORNE L and GRITSCH H (2018) Fibrin Sealant Sclerotherapy for Treatment of Lymphoceles Following Renal TransplantationJournal of Urology, VOL. 170, NO. 2, (380-383), Online publication date: 1-Aug-2003.HSU T, GILL I, GRUNE M, ANDERSEN R, ECKHOFF D, GOLDFARB D, GRUESSNER R, HODGE E, MUNCH L, NGHIEM D, NYE A, RECKARD C, SHAVER T, STRATTA R and TAYLOR R (2018) LAPAROSCOPIC LYMPHOCELECTOMY: A MULTI-INSTITUTIONAL ANALYSISJournal of Urology, VOL. 163, NO. 4, (1096-1099), Online publication date: 1-Apr-2000.KIBERD B, PANEK R, CLASE C, MacDONALD A, McALISTER V, BELITSKY P and LAWEN J (2018) THE MORBIDITY OF PROLONGED WOUND DRAINAGE AFTER KIDNEY TRANSPLANTATIONJournal of Urology, VOL. 161, NO. 5, (1467-1469), Online publication date: 1-May-1999.Gill I, Hodge E, Munch L, Goldfarb D, Novick A, Lucas B and Clayman R (2018) Transperitoneal Marsupialization of Lymphoceles: A Comparison of Laparoscopic and Open TechniquesJournal of Urology, VOL. 153, NO. 3, (706-711), Online publication date: 1-Mar-1995. Volume 150Issue 1July 1993Page: 22-26 Advertisement Copyright & Permissions© 1993 by The American Urological Association Education and Research, Inc.Keywordstransplantation, homologouskidney transplantationlymphoceleMetricsAuthor Information Raja B. Khauli More articles by this author Jeffrey S. Stoff More articles by this author Tammy Lovewell More articles by this author Reza Ghavamian More articles by this author Stephen Baker More articles by this author Expand All Advertisement Loading ...