Abstract
Introduction
Lymphyocele by definition is the collection of lymph that is contained by a pseudomembrane. Management of lymphocele varies from simple aspiration or aspiration with sclerothreapy to more invasive technique, such as internal/external drainage. We present the results of 36 patients who developed pelvic lymphocele after renal transplant.
Materials and methods
A total of 1720 patients underwent living related donor renal allograft transplant at our centre. Of the total 1720 transplants 36 patients developed symptomatic lymphocele and underwent definitive management. Retrospectively analysis of the clinical data of these 36 patients was done.
Results
Thrirt six patients (2.09%) had a clinically significant lymphocele, which needed definitive management. All these patients underwent ultrasound guided drain placement and sclerosant injection. Fifteen out of 36 patients (41.6%) had successful treament with percutaneous drain placement. Laparoscopic marsupialization of lymphocele was done in 21 patients who failed percutaneous drain insertion therapy after diagnostic aspiration. Laparoscopic Marsupilization was successful in 18 out of 21 patients (85.7%). The 3 patients with failed laparoscopic marsupialization were managed with open surgical marsupialization.
Conclusion
Significant number of lymphocele post renal transplant may be asymptomatic but still cause deterioration of renal function even without causing obstructive uropathy. Lymphoceles causing renal deterioration or symptoms should be managed in a step ladder fashion starting from percutaneous drainage to laparoscopic marsupilization to open surgical approach. Asymptomatic recurrences post marsupialization are common and should be only closely observed unless they become symptomatic or cause deterioration of renal function. A systematic protocol may help in treating these patients better.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Braun WE, Banowsky LH, Straffon RA, Nakamoto S, Kiser WS, Popowniak KL, Hewitt CB, Stewart BH, Zelch JV, Magalhaes RL, Lachance JG (1974) Lymphoceles associated with renal transplantation: report of 15 cases and review of the literature. Am J Med 57(5):714–729
Gomes AS, Scholl D, Feinberg S, Simmons RL (1979) Amplatz K. Lymphangiography and ultrasound in management of lymphoceles. Urology 3(1):104–108
Koene RA, Skotnicki SH, Debruyne FM (1979) Spontaneous renal decapsulation with excessive fluid leakage after transplantation. N Engl J Med 300(18):1030–1031
Sollinger HW, Starling JR, Oberley T, Glass NR, Belzer FO (1983) Severe “weeping” kidney disease after transplantation: a case report. Transplant Proc 15(4):2157–2160
Khauli RB, Stoff JS, Lovewell T, Ghavamian R, Baker S (1993) Post-transplant lymphoceles: a critical look into the risk factors, pathophysiology and management. J Urol 150(1):22–26
Khauli RB, Mosenthal AC, Caushaj PF (1992) Treatment of lymphocele and lymphatic fistula following renal transplantation by laparoscopic peritoneal window. J Urol 147(5):1353–1355
Teruel JL, Escobar E, Quereda C, Mayayo T, Ortuno J (1983) A simple and safe method for management of lymphocele after renal transplantation. J Urol 130(6):1058–1059
Williams G, Howard N (1981) Management of lymphatic leakage after renal transplantation. Transplantation 31(2):134
Gill I, Hodge E, Munch L, Goldfarb D, Novick A, Lucas B, Clayman R (1995) Transperitoneal marsupialization of lymphoceles: a comparison of laparoscopic and open techniques. Commentary. J Urol 153(3):706–711
Ziȩtek Z, Sulikowski T, Tejchman K, Sieńko J, Janeczek M, Iwan-Ziȩtek I, Kȩdzierska K, Rość D, Ciechanowski K, Ostrowski M (2007) Lymphocele after kidney transplantation. Transplant Proc 39(9):2744–2747
Mulgaonkar S, Jacobs MG, Viscuso R, Lyman N, Klein P, Bravo B, Clavello A, Filippone D, Dembner A (1992) Laparoscopic internal drainage of lymphocele in renal transplant. Am J Kidney Dis 19(5):490–492
Clayman RV, So SS, Jendrisak MD, Hanto DW (1991) Laparoscopic drainage of a posttransplant lymphocele. Transplantation 51(3):725–726
Duepree HJ, Fornara P, Lewejohann JC, Hoyer J, Bruch HP, Schiedeck TH (2001) Laparoscopic treatment of lymphoceles in patients after renal transplantation. Clin Transplant 15(6):365–369
Elder R, Schweizer RT (1983) Pelvic lymphocele causing fatal pulmonary embolus in kidney transplant recipient. Transplant Proc 15(4):2164–2167
Längle F, Schurawitzki H, Mühlbacher F, Steininger R, Watschinger B, Derfler K, Stockenhuber F, Piza F (1990) Treatment of lymphoceles following renal transplantation. Transplant Proc 22(4):1420–1422
Kidney Disease (2009) Improving Global Outcomes (KDIGO) Transplant Work Group. KDIGO clinical practice guideline for the care of kidney transplant recipients. Am J Transplant 9:S27
Sabnis RB, Singh AG, Ganpule AP, Chhabra JS, Tak GR, Shah JH (2016) The development and current status of minimally invasive surgery to manage urological complications after renal transplantation Indian J Urol 32(3):186–191
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
None.
Ethical standards
All ethical standards abided to.
Rights and permissions
About this article
Cite this article
Singh, A.G., Jai, S.J., Ganpule, A.P. et al. Critical appraisal of consecutive 36 cases of post renal transplant lymphocele: a proposed algorithm. World J Urol 35, 1443–1450 (2017). https://doi.org/10.1007/s00345-016-1997-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00345-016-1997-x