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.

Background: Ultrasound examination is frequently used to evaluate the graft after renal transplantation and to detect possible lymphoceles. The fi rst ultrasound scan in our hospital is normally performed on the day of discharge. We questioned whether perirenal fl uid collections detected by ultrasound examination at discharge are predictive for future symptomatic lymphoceles. Methods:All ultrasound reports of all renal transplant recipients treated in our hospital between January 2010 and December 2017 were collected and screened for abnormalities such as fl uid collections. Patients that developed a symptomatic lymphocele were compared with a control group from the same cohort. Sensitivity and specifi city of ultrasound examination to detect symptomatic lymphoceles were calculated for the primary and consecutive ultrasounds tests.Results: There were no signifi cant differences at baseline characteristics between the Symptomatic lymphocele group and control group, with the exception of mean age at kidney transplantation (47 ± 17 years in the control group vs. 56 ± 13 years in the symptomatic lymphocele group, p=0.02).The ultrasound examination at discharge had a sensitivity of 31% and specifi city of 87% to detect future symptomatic lymphoceles. The positive predictive value was only 10%. The second ultrasound test had the best test variables to detect symptomatic lymphoceles with a sensitivity of 93% and a specifi city of 87% and a predictive value of 28%. Conclusion:Routinely use of ultrasound testing on the day of discharge does detect perirenal fl uid collections, but is not predictive for development of symptomatic lymphoceles in the future.