Single cohort study: ABO-incompatible kidney transplant recipients have a higher risk of lymphocele formation

  • Bernd Martin JänigenEmail author
  • Chiara Salabè
  • Torben Glatz
  • Oliver Thomusch
  • Claudia Lässle
  • Stefan Fichtner-Feigl
  • Stefan Zschiedrich
  • Przemyslaw Pisarski
Original Article



Since 2004, ABO-incompatible kidney transplantation (ABOi KTx) became an established procedure to expand the living donor pool in Germany. Currently, ABOi KTx comprises > 20% of all living donor KTx. Up to September 2015, > 100 ABOi KTx were performed in Freiburg. Regarding lymphocele formation, only scarce data exist.


Between April 2004 and September 2015, 106 consecutive ABOi and 277 consecutive ABO-compatible kidney transplantations (ABOc KTx) were performed. Two ABOi and 117 ABOc recipients were excluded due to differences in immunosuppression. One hundred-four ABOi and 160 ABOc KTx patients were analyzed concerning lymphocele formation.


The incidence of lymphoceles in ABOi KTx was 25.2% and 10.6% in ABOc KTx (p = 0.003). A major risk factor appeared the frequency of ≥ 8 preoperative immunoadsorption and/or plasmapheresis sessions (OR 5.61, 95% CI 2.31–13.61, p < 0.001). Particularly, these ABOi KTx recipients had a distinctly higher risk of developing lymphocele (40.0% vs. 19.2%, p = 0.044). IA/PE sessions on day of transplantation (no lymphocele 20.0% vs. lymphocele 28.6%, p = 0.362) or postoperative IA/PE sessions (no lymphocele 25.7% vs. lymphocele 24.1%, p = 1.0) showed no influence on formation of lymphoceles.


In ABOi KTx, the incidence of lymphocele formation is significantly increased compared to ABOc KTx and leads to more frequent surgical reinterventions without having an impact on graft survival.


ABO-incompatible kidney transplantation Renal transplantation Blood group-incompatibility Immunoadsorption Surgical complications 



blood group compatible


blood group incompatible


body mass index




double-J catheter


red blood cell transfusion




kidney transplantation




panel reactive antibody


United States Renal Data System



We thank Dr. Erika Graf (IMBI Freiburg) for the very helpful statistical consultation enhancing clarity of data presentation.

Author contributions

BMJ: study conception and design, drafting of manuscript, interpretation of data, transplant surgeon. CS: acquisition of data. TG: analysis of data. OT: critical revision of manuscript. CL: critical revision of manuscript. SFF: critical revision of manuscript. SZ: study conception and design, critical revision of manuscript. PP: critical revision of manuscript, principal transplant surgeon.

Compliance with ethical standards

The registry and the study were approved by the ethics committee of the University Medical Center Freiburg and in accordance with the Declaration of Helsinki.

All patients of the Freiburg living donor kidney program gave informed consent for collecting and storing their data in our living donor transplant registry for analysis for research purposes.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of General and Digestive Surgery, Section of Transplant Surgery, Faculty of MedicineMedical Center – University of FreiburgFreiburg im BreisgauGermany
  2. 2.Department of Medicine IV, Faculty of MedicineMedical Center – University of FreiburgFreiburg im BreisgauGermany

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