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

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Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusion

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.

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Abbreviations

ABOc:

blood group compatible

ABOi:

blood group incompatible

BMI:

body mass index

CMV:

cytomegalovirus

DJ:

double-J catheter

EC:

red blood cell transfusion

IA:

immunoadsorption

KTx:

kidney transplantation

PP:

plasmapheresis

PRA:

panel reactive antibody

USRDS:

United States Renal Data System

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Acknowledgments

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

Author information

Author notes

  1. Stefan Zschiedrich and Przemyslaw Pisarski shared senior authorship

Authors and Affiliations

  1. Department of General and Digestive Surgery, Section of Transplant Surgery, Faculty of Medicine, Medical Center – University of Freiburg, Freiburg im Breisgau, Germany

    Bernd Martin Jänigen, Chiara Salabè, Torben Glatz, Oliver Thomusch, Claudia Lässle, Stefan Fichtner-Feigl & Przemyslaw Pisarski

  2. Department of Medicine IV, Faculty of Medicine, Medical Center – University of Freiburg, Freiburg im Breisgau, Germany

    Stefan Zschiedrich

Authors
  1. Bernd Martin Jänigen
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  2. Chiara Salabè
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  8. Przemyslaw Pisarski
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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.

Corresponding author

Correspondence to Bernd Martin Jänigen.

Ethics declarations

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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Jänigen, B.M., Salabè, C., Glatz, T. et al. Single cohort study: ABO-incompatible kidney transplant recipients have a higher risk of lymphocele formation. Langenbecks Arch Surg 404, 999–1007 (2019). https://doi.org/10.1007/s00423-019-01812-y

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  • DOI: https://doi.org/10.1007/s00423-019-01812-y

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