Treatment of the Lymphocele After Kidney Transplantation: A Single-center Experience

• Lymphoceles are usually innocuous and asymptomatic, but can equally cause dramatic presentations.
• The size of the lymphocele had no direct impact on clinical symptoms.
• The indications for fenestration of lymphocele are the symptoms of compression on vessels and ureter in ultrasound imaging, and deterioration of the kidney graft.
• Fenestration is a safe and effective method of treatment of symptomatic, high-pressure lymphocele.
• ARE, DGF, and older age are risk factors for LRT.

BackgroundLymphocele is one of the most common complications after kidney transplantation. It is usually asymptomatic, but can cause pressure on the kidney transplant, ureter, bladder, and adjacent vessels with deterioration of graft function, ipsilateral leg edema, and external iliac vein thrombosis. Peritoneal fenestration is a well-established method for treatment. In this report, we present the incidence of symptomatic lymphocele requiring treatment (LRT), demographic and surgical factors that influenced lymphocele formation, its clinical presentation, and 2 types of treatment: open and laparoscopic intraperitoneal drainage in the experience of our center.Material and MethodsWe retrospectively analyzed all kidney transplantations performed between January 2007 and December 2014 in Gdansk Transplantation Center (n = 740) and selected patients with LRT. LRT occurred in 59 cases (8%). All other patients transplanted during the same time (n = 681) were treated as a control group in the univariate and multivariate analysis of risk factors of the lymphocele formation.ResultsSurgical intraperitoneal drainage was performed in an open method in 53 cases and laparoscopically in 6 patients. We observed recurrence of lymphocele in 11 cases (18.6%). Acute rejection episodes (ARE) and delayed graft function (DGF) were more frequent in patients with LRT. ARE and age were independent risk factors for LRT in multivariate analysis. The mean estimated glomerular filtration rate by the Modification of Diet in Renal Disease method at 1 month after the fenestration was higher than before the operation (51.7 and 43.6 mL/min, respectively).ConclusionsFenestration is a safe and effective method of treatment of symptomatic lymphocele. ARE, DGF, and older age were associated with a greater risk of LRT.