Consensus on definition and severity grading of lymphatic complications after kidney transplantation

Abstract

Background: The incidence of lymphatic complications after kidney transplantation varies considerably in the literature. This is partly because a universally accepted definition has not been established. This study aimed to propose an acceptable definition and severity grading system for lymphatic complications based on their management strategy. Methods: Relevant literature published in MEDLINE and Web of Science was searched systematically. A consensus for definition and a severity grading was then sought between 20 high-volume transplant centres.Results: Lymphorrhoea/lymphocele was defined in 32 of 87 included studies. Sixty-three articles explained how lymphatic complications were managed, but none graded their severity. The proposed definition of lymphorrhoea was leakage of more than 50 ml fluid (not urine, blood or pus) per day from the drain, or the drain site after removal of the drain, for more than 1 week after kidney transplantation. The proposed definition of lymphocele was a fluid collection of any size near to the transplanted kidney, after urinoma, haematoma and abscess have been excluded. Grade A lymphatic complications have a minor and/or non-invasive impact on the clinical management of the patient; grade B complications require non-surgical intervention; and grade C complications require invasive surgical intervention.Conclusion: A clear definition and severity grading for lymphatic complications after kidney transplantation was agreed. The proposed definitions should allow better comparisons between studies.

Minimal-invasive management of urological complications after kidney transplantation

“…The formation of lymphatic fistula after RT is a common complication occurring in up to 20% of the cases [96][97][98], caused by dissection of lymphatic vessels of the donor kidney during preparation and recipient pelvis during allograft implantation. Data indicates that the use of an absorbable polysaccharide hemostatic powder (HaemoCer™) can reduce the incidence of lymphatic fistula [99].…”

Validating Consensus-Defined Severity Grading of Lymphatic Complications after Kidney Transplant

“…Lymphoceles can lead to further complications, such as impaired wound healing, thrombosis, and organ failure. The reported incidences of lymphoceles after KTx vary widely (from 0.6% to 51%) [ 2 , 3 , 4 ]. This vast discrepancy in the reported incidences can be attributed to the lack of a standardized definition for post-KTx lymphatic complications but also to differences in the means of routine postoperative diagnosis and distinct follow-up protocols [ 5 , 6 ].…”

“…Mehrabi et al addressed the lack of an objective definition for lymphoceles that follow KTx [ 4 ] in a systematic review that evaluated existing definitions and suggested a consensus-defined severity grading for post-KTx lymphoceles. They found that lymphoceles were defined as a fluid collection of any size near the transplanted kidney after urinoma, hematoma, and abscess were excluded.…”

“…They found that lymphoceles were defined as a fluid collection of any size near the transplanted kidney after urinoma, hematoma, and abscess were excluded. Based on their review, Mehrabi et al classified lymphoceles as grade A, B, or C depending on how severely they affected clinical management [ 4 ]. However, to date, this classification has not been validated in an independent patient cohort.…”

“…Severity grading of lymphatic complications after kidney transplantation based on the consensus from Mehrabi et al[4].…”