Share this Article
Sim A, Ng LG, Cheng C
Correspondence: Dr Allen Sim, firstname.lastname@example.org
Introduction The incidence of lymphoceles – lymphatic collections around a transplanted kidney – can be as high as 20%. We aimed to review the presentation, treatment and outcome of patients with lymphoceles.
Methods We reviewed a prospective database of 154 patients who underwent renal transplantation at our hospital from January 2005 to November 2008.
Results The mean age of the patients in our cohort was 46 (range 34–58) years. The incidence of lymphoceles in our series was 5.8% (n = 9). The median onset was 19 (range 6–28) days post-transplantation, while the median size of the lymphoceles was 5 (range 1.5–8) cm. Lymphoceles were most commonly found at the lower pole of the transplanted kidney. Eight patients with lymphoceles had received cadaveric transplants. While a majority of these patients did not have hydronephrosis on presentation, four had markedly elevated creatinine. Of the nine patients with lymphoceles, six were on macrolides (tacrolimus, sirolimus or everolimus), two were successfully managed conservatively, three were managed percutaneously and four required surgical drainage via either laparoscopic marsupialisation (n = 1) or open drainage (n = 3). There was no graft loss.
Conclusion It remains unknown whether the choice of immunosuppressants increases the risk of lymphocele formation. Intervention is necessary in the case of impaired drainage of the pelvicalyceal system in these patients. Minimally invasive intervention, while effective in treating lymphoceles, does not provide definitive treatment. Surgical intervention should be considered early for the treatment of post-transplantation patients with lymphoceles, so as to shorten hospital stay and prevent further complications.
Keywords: lymphocele, renal transplant
Singapore Med J 2013; 54(5): 259-262; http://dx.doi.org/10.11622/smedj.2013104
| 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 multiinstitutional 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. Percutaeneous 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. |
|8. Kim JK, Jeong YY, Kim YH, et al. Postoperative pelvic lymphocele: treatment with simple percutaneous catheter drainage. Radiology 1999; 212:390-4.|
| 9. Bischof G, Rockenschaub S, Berlakovich G, et al. Management of lymphoceles after kidney transplantation. Transpl Int 1998; 11:277-80 . |
| 10. 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. |
| 11. 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. |
| 12. 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. |
| 13. 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. |
| 14. 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. |
| 15. 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. |