Objective: To determine the impact of our surgical techinique with the incidence of lymphoceles in all patients who underwent renal transplantation, and identify other risk factors responsible for the development of lymphoceles.
Materials and Methods: The records of all patients who underwent kidney transplantation at the Riyadh Military Hospital from March 2007 to March 2011 were retrospectively reviewed to determine the incidence of lymphocele. Demographic characteristics, risk factors, and surgical technique were outlined. All transplants were performed by a single surgeon and his team.
Results: A total of 273 patients underwent kidney transplantation; only 1 recipient was diagnosed with a lymphocele on ultrasound 6 weeks after transplantation. This patient underwent ultrasound-guided aspiration with complete resolution without recurrence at a 1-year follow-up. Our surgical technique is based on (1) ligation of all paravascular hilar tissue in the allograft, (2) ligation and division of all lymphatic vessels when dissecting the recipient iliac artery and vein, (3) ligation and division of all lymphatics if iliac lymph nodes require removal, and (4) routine use of suction drains. The known risk factors are comparable with other studies and include an acute rejection (AR) rate of 6.6%, a body mass index (BMI) >30 to 24%, diabetes at 22%, retransplants at 15%, zero de novo sirolimus therapy, and 14.6% recipients on a steroid-free regimen.
Discussion: Post-renal transplant lymphoceles are not uncommon and can result in unnecessary morbidity. These patients can present with a palpable mass, renal impairment from obstruction of the ureter, lower limb edema from iliac vein thrombosis, and sepsis in case of infection. Diagnosis and follow-up with an ultrasound (US) is simple and efficient. The prevention of lymphoceles may be possible with meticulous surgical techniques where all lymphatics are carefully ligated. The reduction of known risk factors can also help reduce its incidence and morbidity. Treatment options include aspiration, sclerosant instillation, and surgery, but lymphoceles can recur and every effort must be made to reduce its incidence.
Conclusion: We feel that a meticulous surgical technique with ligation of all lymphatics, both during dissection of the recipient vessels and the donor allograft, along with appropriate suction drainage, was significant in reducing the incidence of lymphoceles following kidney transplantation in our recipients.
Taqi F Toufeeq Khan, Mirza Anzar Baig
Submitted: June 11, 2011
Accepted for Publication: Aug 12, 2011
KEYWORDS: Post-renal transplant lymphocele; Meticulous surgical technique; Ligation of lymphatics; Risk factors; Incidence
CORRESPONDENCE: Taqi F Toufeeq Khan, Division of Kidney Transplant Surgery, PO Box 7897/624N, Riyadh Military Hospital, Riyadh, 11159, Kingdom of Saudi Arabia ( ).
CITATION: Urotoday Int J. 2011 Oct;4(5):art 64
doi: 10.3834/uij.1944-5784.2011.10.07