Abstract
PurposeThe development of a symptomatic lymphocele (SL) is a frequent postoperative surgical complication after kidney transplantation. It may lead to pain and discomfort and cause transplant malfunction or even secondary graft loss. A large cohort of renal recipients was investigated to identify the possible risk factors for SL.MethodsAll renal transplant patients of a single centre were retrospectively analysed for SL between January 2010 and December 2017. The SL group was compared to a control group from the same cohort.Results45 out of 1003 transplanted patients developed an SL (incidence 4.5%), on average 50 days after kidney transplantation. SLs developed more in older patients, in those with a PD catheter and in ADKDP as primary diagnosis. Surgical predictors for SLs were venous anastomosis on the external iliac vein, concomitant PD catheter removal, perfusion defects, shorter operating time, splint > 7 days, double J stenting, discharge with drain, low initial drain production and ureteral obstruction. Opening of the peritoneum, re-operation for postoperative bleeding and previous nephrectomy seem protective for developing SL.ConclusionWe found multiple heterogeneous predictors for SL with a common denominator related to surgical management of the retroperitoneal space, peritoneum and the ureter. Future prospective studies are necessary to evaluate the influence of these variables on the development of SL.
Highlights
One of the most frequently observed postoperative complications of kidney transplantation is a symptomatic perirenal fluid collection, such as a haematoma, a lymphocele or lymphorrhea
Patients in the symptomatic lymphocele (SL) group had a higher age in comparison with the control group (56 ± 13 vs. 47 ± 17 years, P = 0.017), more patients had a PD catheter at the moment of transplantation (22% vs. 18%, P = 0.007) and more patients in the SL group were diagnosed with Autosomal dominant polycystic kidney disease (ADPKD) (31% vs. 16%, P = 0.001)
Multiple heterogeneous surgical and non-surgical predictors were related to SL, a common denominator seems to relate to the management of the retroperitoneal space, peritoneum and the ureter
Summary
One of the most frequently observed postoperative complications of kidney transplantation is a symptomatic perirenal fluid collection, such as a haematoma, a lymphocele or lymphorrhea. A lymphocele in renal transplant recipients is a pseudo-cystic entity filled with lymph fluid, covered with a hard fibrous capsule, localized around the graft. The incidence of lymphoceles after kidney transplantation varies widely and is reported between 0.03% and 33.9% with a mean incidence of 5.2% [1,2,3,4,5,6,7,8]. Lymphoceles are diagnosed primarily by sonographic imaging and occur from 2 weeks up to 6 months after transplantation with a peak incidence at 6 weeks [9]. Symptomatic lymphoceles (SLs), cause pain and discomfort mainly due to
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