2. LONG-TERM PROSPECTIVE SAFETY AND EFFICACY OF VASCULARIZED LYMPH NODE TRANSPLANT (VLNT)

Abstract

PURPOSE: Despite the increasing popularity of vascularized lymph node transplant (VLNT), there is lack of prospective long-term outcomes data and standardized outcome metrics, specifically following Vascularized Omentum Lymphatic Transplant (VOLT). The purpose of this IRB-approved prospective study was to evaluate the long-term outcomes of VLNT using a comprehensive set of outcome measures. METHODS: All patients underwent VLNT at our institution between November 2014 and July 2020. Demographic data, volume measurements, bio-impedance scores, Quality of Life scores and cellulitis episodes were recorded. RESULTS: A total of 89 patients with a mean follow-up time of 23.7±12 months were included. Donor sites consisted of the omentum (73%), axilla (13%), supraclavicular (7%), groin (3.5%), and others. 20% decrease (p=0.0239) in volume differential, and 27.5% decrease (p=0.0398) in L-DEX scores were recorded 2 years after VLNT. A significant improvement in Lymphedema Life Impact Scale (LLIS) scores manifested as 28.4% decrease (p=0.0398) was recorded 2 years after treatment. In addition, VLNT dramatically decreased the total number of cellulitis episodes by 93% (p=0.0008) 1 year after treatment as well as the average number of episodes per year (84.5% decrease, p=0.0002). No cases of donor site lymphedema were recorded (0%). CONCLUSION: This prospective study demonstrated satisfactory reduction in limb volume, bioimpedance, and improved quality of life. This is the largest long-term prospective study of VOLTs in comparison to most studies evaluating peripheral VLNT. VOLT is a reliable alternative to peripheral VLNT with no risk of donor site lymphedema and particularly significant impact in reducing the incidence of cellulitis.