Post-Transplant Lymphoceles: A Critical Look into the Risk Factors, Pathophysiology and Management

Abstract

To define better the prevalence and pathophysiology of lymphoceles following renal transplantation, we prospectively evaluated 118 consecutive renal transplants performed in 115 patients (96 cadaveric, 22 living-related, 7 secondary and 111 primary). Ultrasonography was performed post-operatively and during rehospitalizations or whenever complications occurred. Perirenal fluid collections were identified in 43 patients (36%). Lymphoceles with a diameter of 5 cm. or greater were identified in 26 of 118 cases (22%). Eight patients (6.8%) had symptomatic lymphoceles requiring therapy. The interval for development of symptomatic lymphoceles was 1 week to 3.7 years (median 10 months). Risk factors for the development of lymphoceles were examined by univariate and multivariate analysis, and included patient age, sex, source of transplants (cadaver versus living-related donor), retransplantation, tissue match (HLA-B/DR), type of preservation, arterial anastomosis, occurrence of acute tubular necrosis-delayed graft function, occurrence of rejection, and use of high dose corticosteroids. Univariate analysis showed a significant risk for the development of lymphoceles in transplants with acute tubular necrosis-delayed graft function (odds ratio 4.5, p = 0.004), rejection (odds ratio 25.1 p < 0.001) and high dose steroids (odds ratio 16.4, p < 0.001). When applying multivariate analyses using stepwise logistic regression, only rejection was associated with a significant risk for lymphoceles (symptomatic lymphoceles--odds ratio 25.08, p = 0.0003, all lymphoceles--odds ratio 75.24, p < 0.0001). When adjusting for rejection, no other risk factor came close to being significant (least p = 0.4). Therapy included laparoscopic peritoneal marsupialization and drainage in 1 patient, incisional peritoneal drainage in 4 and percutaneous external drainage in 3 (infected). All symptomatic lymphoceles were successfully treated without sequelae to grafts or patients. We conclude that allograft rejection is the most significant factor contributing to the development of lymphoceles. Therapy of symptomatic lymphoceles should be individualized according to the presence or absence of infection.

Assessment of lymphocele incidence following 450 renal transplantations

“…It is believe that extensive perivascular dissection along the route of iliac vessels, episodes of acute rejection, cadaveric versus live donors, high doses of corticotherapy, re-transplantation, and polycystic disease in the recipients, are factors that contribute to the development of fluid collections. Nevertheless, little has been done to prevent the occurrence of lymphocele, besides preventing acute rejection (1,5).…”

“…Lymphoceles are the fluid collections most frequently found following renal transplantation, occurring in up to 22% of transplantations performed in the United States every year (1). The risk of developing a lymphocele is associated to previous episode of acute rejection, incomplete ligation of lymphatic vessels in the graft, high doses of steroids and extensive perivascular dissection in the recipient, among other causes (1).…”

“…The risk of developing a lymphocele is associated to previous episode of acute rejection, incomplete ligation of lymphatic vessels in the graft, high doses of steroids and extensive perivascular dissection in the recipient, among other causes (1).…”

Povidone-Iodine Instillation for Management of Pelvic Lymphocele After Pelvic Lymphadenectomy for Staging Prostate Cancer

“…Laparoscopic peritoneal drainage under general anesthesia has played a role in lymphocele management since 1991. However, this technique requires greater skill and supportive facilities, and visceral injuries occur occasionally [2,[4][5][6]. The advantages of this treatment as compared with percutaneous approaches are perhaps less clear [2,4].…”

“…It is a well-recognized complication of renal transplantation, with incidence rates up to 20% [2]. Although small lymphoceles may remain undetected, larger ones can manifest as lower abdominal masses, ipsilateral lymphedema, continued incisional drainage, fever, weight gain, and tenderness in the iliac fossa [4,11,12]. Treating the rare, large, and symptomatic lymphocele is often difficult.…”