The Use of a Polymeric Sealant for Prevention of Posttransplantation Lymphocele

Abstract

The aim of this study was to investigate the effectiveness of a synthetic polyethy lenglycol (PEG) sealant to prevent lymphocele formation after kidney transplantation. The examined group consisted of 719 recipients including 294 female and 425 male who were immunosuppressed with a calcineurin inhibitor, plus basiliximab since 1999, and with mycophenolate mofetil in addition since 2000. We retrospectively analyzed the incidence of lymphoceles among 545 recipients operated between November 1999 and November 2007 (group I), 93 recipients at standard risk for lymphocele transplanted between December 2007 and December 2009 (group II) in whom we performed only routine ligation of the lymphatic vessels during preparation of the graft, and 31 patients also transplanted between December 2007 and December 2009 who were at higher risk for lymphocele (group III) and underwent an off-label application of the PEG sealant. There was no significant difference in patient demographic features among the groups. In total, 21 group I, patients (3.5%) developed symptoms of a lymphocele that required Ն1 corrective procedures, whereas only 1 group II patient (1.07%) developed a lymphocele and no group III patient evidenced a symptomatic lymphocele. No adverse events were observed among group III patients after PEG sealant application. although the preliminary results are interesting, a prospective randomized study is required to assess the costeffectiveness of PEG sealant to prevent lymphocele formation.

Prophylaxis of lymphocele formation after kidney transplantation via peritoneal fenestration: a systematic review

“…However, lymphoceles may also affect graft function by causing direct pressure to the kidney, or by compressing the ureter or transplant vasculature. In addition, ipsilateral leg or genital oedema and deep vein thrombosis after compression of the external iliac vein may occur .…”

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

“…). Eighty‐seven articles met the inclusion criteria and were included in the report. Seventy‐six articles reported on lymphoceles only, four articles on lymphorrhoea, and seven articles on lymphocele and lymphorrhoea.…”

“…Lymphatic complications after kidney transplantation have not been graded before, except into asymptomatic and symptomatic categories. Lymphoceles are not usually managed according to their size, although Hamza and co‐workers treated all lymphoceles greater than 80 ml, irrespective of the symptoms, and Dubeaux et al . 38 operated on asymptomatic lymphoceles based on their size.…”

“…Location and accessibility are also important factors. If the lymphocele is located deep within the pelvic cavity adjacent to the iliac vessels or inferomedially, aspiration may be difficult or impossible, and surgery is the only possibility. Septation of the lymphocele also influences the therapeutic approach.…”

“…Septation of the lymphocele also influences the therapeutic approach. Zargar‐Shoshtari and co‐workers demonstrated that aspiration was possible for non‐loculated lymphoceles, whereas loculated ones should be treated surgically.…”