Title: Management of Lymphocele Formation Following Kidney Transplantation: A Single Centre Experience
Authors: Shanky Singh, Vaibhav Vikas, Priyabrat Das, Jatin Soni
DOI: https://dx.doi.org/10.18535/jmscr/v5i6.127
Abstract
Background: A lymphocele is defined as a collection of lymph that accumulates in the postoperative field in a nonepithelialized cavity. Incidence ranges from 0.6% to 18% depending on various studies.1 Management of lymphocele varies from simple aspiration or aspiration with sclerotherapy to more invasive technique, such as internal/external drainage.2-9 We present our experience in the management of 13 patients who developed pelvic lymphocele after renal transplant.
Materials and Methods: Between January 2014 and December 2016, a total of 13 patients after renal transplant were treated in our institution for post-transplant lymphocele formation that occurred during follow-up at the transplant outpatient department. Retrospectively analysis of the clinical data of these patients was done.
Results: All thirteen patients who had a clinically significant lymphocele post renal transplant underwent first ultrasound guided aspitation of lymphocele. Five out of 13 patients had successful treament with percutaneous aspiration alone. Two patients became assymptomatic after percutaneous drain placement and sclerosant injection. Six patients who failed percutaneous drain insertion therapy after aspiration underwent marsupilization. Laparoscopic marsupilization was done in four patients and open marupilization was done in one patient.One patient had open procedure after failed laparoscopy procedure.
Conclusion: Most patients with lymphocele post renal transplant may be asymptomatic. Management of lymphocele depend upon symptoms and renal function and should be in a step ladder fashion . It usually starts from percutaneous drainage to laparoscopic marsupilization to open surgical approach.
Keywords: Lymphocele; Percutaneous drainage; Marsupialization; Post renal transplant.
References
1. Braun WE, Banowsky LH, Straffon RA, et al. Lymphocele associated with renal transplantation: Report of 15 cases and review of the literature. Am J Med 1974; 57:714-29.
2. Hsu TH, Gill IS, Grune MT, et al. Laparoscopic lymphocelectomy: a multii-nstitutional analysis. J Urol 2000; 163:1096-8.
3. Fuller TF, Kang SM, Hirose R, et al. Laparoscopic treatment of symptomatic lymphocele after renal transplantation: laparoscopic versus open drainage. J Urol 2003; 169:2022-5.
4. Zuckerman DA, Yeager TD. Percuta-eneous ethanol sclerotherapy of postoperative lymphoceles. AJR Am J Roentgenol 1997; 169:433-7.
5. Hamza A, Fischer K, Koch E, et al. Diagnostic and therapy of lymphoceles after kidney transplantation. Transplant Proc 2006; 38:701-6.
6. Tasar M, Gulec B, Saglam M, et al. Posttransplant symptomatic lymphocele treatment with percutaneous drainage and ethanol sclerosis: long term follow up. Clin Imaging 2005; 29:109-16. 7. Atray NK, Moore F, Zaman F, et al. Post transplant lymphocele: a single centre experience. Clin Transplant 2004; 18 suppl 12:46-9.
7. Kim JK, Jeong YY, Kim YH, et al. Postoperative pelvic lymphocele: treat-ment with simple percutaneous catheter drainage. Radiology 1999; 212:390-4.
8. Bischof G, Rockenschaub S, Berlakovich G, et al. Management of lymphoceles after kidney transplantation. Transpl Int 1998; 11:277-80 .
9. Manfro RC, Comerlato L, Berdichevski RH, et al. Nephrotoxic acute renal failure in a renal transplant patient with recurrent lymphocele treated with povidone-iodine irrigation. Am J Kidney Dis 2002; 40:655-7.
10. Adani GL, Baccarani U, Bresadola V, et al. Graft loss due to percutaneous sclerotherapy of a lymphocele using acetic acid after renal transplantation. Cardiovasc Intervent Radiol 2005; 28:836-8.
11. Krol R, Kolonko A, Chudek J, et al. Did volume of lymphocele after kidney transplantation determine the choice of treatment modality? Transplant Proc 2007; 39:2740-3.
12. Chiu MI, Katz H, Berlin V. RAPT1, a mammalian homolog of yeast TOR, interacts with the FKBP12/rapamycin complex. Proc Natl Acad Sci U S A 1994; 91:12574-8.
13. Kahan BD. Efficacy of sirolimus compared with azathioprine for reduction of acute renal allograft rejection: a randomised multicentre study. The Rapamune US Study Group. Lancet 2000; 356:194-202.
14. Srivastava A, Muruganandham K, Vinodh PB, et al. Post-renal transplant surgical complications with newer immunosuppressive drugs: mycophenolate mofetil vs. m-TOR inhibitors. Int Urol Nephrol 2010; 42:279-84.
15. Sim A, Ng LG, Cheng C. Occurrence of a lymphocele following renal transplantation. Singapore Med J. 2013 May;54(5):259-62.