Does rejection have a role in lymphocele formation post renal transplantation? A single centre experience

Muthu, Veeramani; Mishra, Shashi K; Kurien, Abraham; Ganpule, Arvind; Sabnis, Ravindra; Desai, Mahesh

doi:10.4103/0970-1591.65385

Cited by 11 publications

(7 citation statements)

References 6 publications

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“…Among patients with symptomatic lymphocele, 7.2% had at least 1 rejection episode and 40.4% >1. In addition, they reported a lower graft survival at 10 years in patients with lymphocele compared with those that did not develop lymphatic complications (68.14 versus 76.36%) [ 43 ].…”

Section: Introductionmentioning

confidence: 99%

Lymphatic disorders after renal transplantation: new insights for an old complication

Ranghino¹,

Segoloni²,

Lasaponara

et al. 2015

Clin Kidney J

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In renal transplanted patients, lymphoceles and lymphorrhea are well-known lymphatic complications. Surgical damage of the lymphatics of the graft during the procurement and of the lymphatic around the iliac vessels of the recipients has been associated with development of lymphatic complications. However, lymphatic complications may be related to medical factors such as diabetes, obesity, blood coagulation abnormalities, anticoagulation prophylaxis, high dose of diuretics, delay in graft function and immunosuppressive drugs. Consistently, immunosuppression regimens based on the use of mTOR inhibitors, especially in association with steroids and immediately after transplantation, has been associated with a high risk to develop lymphocele or lymphorrhea. In addition, several studies have demonstrated the association between rejection episodes and lymphatic complications. However, before the discovery of reliable markers of lymphatic vessels, the pathogenic mechanisms underlining the development of lymphatic complications during rejection and the influence of mTOR inhibitors remained not fully understood. The recent findings on the lymphatic systems of either native or transplanted kidneys together with the advances achieved on lymphangiogenesis shared some lights on the pathogenesis of lymphatic complications after renal transplantation. In this review, we describe the surgical and medical causes of lymphatic complications focusing on the rejection and immunosuppressive drugs as causes of lymphatic complications.

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Section: Introductionmentioning

confidence: 99%

Lymphatic disorders after renal transplantation: new insights for an old complication

Ranghino¹,

Segoloni²,

Lasaponara

et al. 2015

Clin Kidney J

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“…Of medical risk factors, the association of rejections with lymphocele formation has already been reported in various studies [ 1 , 10 , 16 , 17 , 38 ]. In our cohort, multivariate analysis revealed rejection episodes and delayed graft function as the strongest independent risk factors for development of lymphoceles.…”

Section: Discussionmentioning

confidence: 95%

“…Veeramani et al also report similar graft survival rates with lymphoceles and the control group. However, this cohort consisted primarily of living transplants, since only nine patients of 1709 received a cadaveric allograft [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…Surgical causes comprise dissection of lymphatic tissue around the iliac vessels of the recipient and dissection of the recipient’s lymphatics during procurement or preparation of the organ prior to re-implantation [ 2 ]. In addition, medical factors such as diabetes [ 10 ], high body mass index (BMI), delayed graft function (DGF) [ 12 ], use of mammalian target of rapamycin (mTOR) inhibitors [ 1 , 13 , 14 , 15 ] and acute rejection have been associated with lymphocele formation [ 1 , 10 , 16 ]. Rashid et al described an association of lymphoceles with rejection in 1974 [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

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Analysis of Risk Factors and Long-Term Outcomes in Kidney Transplant Patients with Identified Lymphoceles

Lehner

Hohberger

Marschke

et al. 2020

JCM

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The collection of lymphatic fluids (lymphoceles) is a frequent adverse event following renal transplantation. A variety of surgical and medical factors has been linked to this entity, but reliable data on risk factors and long-term outcomes are lacking. This retrospective single-center study included 867 adult transplant recipients who received a kidney transplantation from 2006 to 2015. We evaluated for patient and graft survival, rejection episodes, or detectable donor-specific antibodies (dnDSA) in patients with identified lymphoceles in comparison to controls. We identified 305/867 (35.2%) patients with lymphocele formation, of whom 72/867 (8.3%) needed intervention. Multivariate analysis identified rejection episode as an independent risk factor (OR 1.61, CI 95% 1.17–2.21, p = 0.003) for lymphocele formation, while delayed graft function was independently associated with symptomatic lymphoceles (OR 1.9, CI 95% 1.16–3.12, p = 0.011). Interestingly, there was no difference in detectable dnDSA between groups with a similar graft and patient survival in all groups after 10 years. Lymphoceles frequently occur after transplantation and were found to be independently associated with rejection episodes, while symptomatic lymphoceles were associated with delayed graft function in our cohort. As both are inflammatory processes, they might play a causative role in the formation of lymphoceles. However, development or intervention of lymphoceles did not lead to impaired graft survival in the long-term.

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“…Thirdly, the growing evidence from observational studies showing that the majority of the symptomatic/large lymphoceles are associated with prior or concomitant rejection episodes [ 1 , 7 – 9 ]. In a prospective study of 118 renal transplants, Khauli et al reported that only AR was associated with a significant risk for lymphoceles by multivariate analysis of risk factors.…”

Section: Discussionmentioning

confidence: 99%

Symptomatic lymphocele developing soon after acute renal allograft rejection: coincidental or causal connection?

Asim

Nauman

2013

Clinical Kidney Journal

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A renal transplant patient developed a lymphocele soon after an episode of acute rejection (AR). The lymphocele rapidly increased in size causing transplant ureteric and venous obstruction, leading to acute graft dysfunction and swelling of the ipsilateral leg. We appraise the complex relationship that exists between AR, lymphangiogenesis and lymphocele formation to determine whether a case for a causal connection between AR and development of lymphocele can be made in our patient.

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Does rejection have a role in lymphocele formation post renal transplantation? A single centre experience

Cited by 11 publications

References 6 publications

Lymphatic disorders after renal transplantation: new insights for an old complication

Lymphatic disorders after renal transplantation: new insights for an old complication

Analysis of Risk Factors and Long-Term Outcomes in Kidney Transplant Patients with Identified Lymphoceles

Symptomatic lymphocele developing soon after acute renal allograft rejection: coincidental or causal connection?

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