Abstract
Development of lymphoceles after renal transplantation is a well-described complication that occurs in up to 40% of recipients. The gold standard approach for the treatment of symptomatic cases is not well defined yet. Management options include simple aspiration, marsupialization by a laparotomy or laparoscopy, and percutaneous sclerotherapy using different chemical agents. Those approaches can be associated, and they depend on type, dimension, and localization of the lymphocele. Percutaneous sclerotherapy is considered to be less invasive than the surgical approach; it can be used safely and effectively, with low morbidity, in huge, rapidly accumulating lymphoceles. Moreover, this approach is highly successful, and the complication rate is acceptable; the major drawback is a recurrence rate close to 20%. We herewith report a renal transplant case in which the patient developed a symptomatic lymphocele that was initially treated by ultrasound-guided percutaneous sclerotherapy with ethanol and thereafter using acetic acid for early recurrence. A few hours after injection of acetic acid in the lymphatic cavity, the patient started to complain of acute pain localized to the renal graft and fever. An ultrasound of the abdomen revealed thrombosis of the renal vein and artery. The patient was immediately taken to the operating room, where the diagnosis of vascular thrombosis was confirmed and the graft was urgently explanted. In conclusion, we strongly suggest avoiding the use of acetic acid as a slerosating agent for the percutaneous treatment of post-renal transplant lymphocele because, based on our experience, it could be complicated by vascular thrombosis of the kidney, ending in graft loss.
Similar content being viewed by others
References
Atray NK, Moore F, Zaman F, et al. (2004) Post transplant lymphocele: A single centre experience. Clin Transplant 18:46–48
Risaliti A, Corno V, Donini A, et al. (2000) Laparoscopic treatment of symptomatic lymphoceles after kidney transplantation. Surg Endosc 14:293–295
Lin CC, Chen WH, Wu CF, et al. (2001) Minilaparotomy for internal drainage of a symptomatic lymphocele after renal transplantation. Med J 24:526–529
Montalvo BM, Yrizarry JM, Casillas VJ, et al. (1996) Percutaneous sclerotherapy of lymphoceles related to renal transplantation. J Vasc Intervent Radiol 7:117–123
Sawhney R, D’Agostino HB, Zinck S, et al. (1996) Treatment of postoperative lymphoceles with percutaneous drainage and alcohol sclerotherapy. J Vasc Intervent Radiol 7:241–245
Akhan O, Cekirge S, Ozmen M, et al. (1992) Percutaneous transcatheter ethanol sclerotherapy of postoperative pelvic lymphoceles. Cardiovasc Intervent Radiol 15:224–227
Oh SJ, Kim SH, Kim HH (2004) Vescicolymphocele fistula following sclerotherapy for lymphocele. J Urol 172:2266
Sang WP, In H C, Kyeong AK, et al. (2004) Percutaneous sclerotherapy using acetic acid after failure of alcohol ablation in an intra-abdominal lymphangioma. Cardiovasc Intervent Radiol 27:285–287
Chin A, Ragavendra N, Hilborne L, et al. (2003) Fibrin sealant sclerotherapy for treatment of lymphoceles following renal transplantation. J Urol 170:380–383
Caliendo MV, Lee DE, Queiroz R, et al. (2001) Sclerotherapy with use of doxycycline after percutaneous drainage of postoperative lymphoceles. J Vasc Interv Radiol 12:73-77
Lin JJ, Sorbi D, Uy JP, et al. (1993) Doxycycline sclerotherapy of lymphocele after renal transplantation and its inhibition of gelatinase activity. Transplant Proc 25:3320–3324
Kerlan RK Jr, LaBerge JM, Gordon RL, et al. (1997) Bleomycin sclerosis of pelvic lymphoceles. J Vasc Intervent Radiol 8:885–887
Teiche PE, Pauer W, Schmid N (1999) Use of talcum in sclerotherapy of pelvic lymphoceles. Tech Urol 5:52–53
Vrouenraets BC, Thompson JF, McCarthy WH (1998) Treatment of large, persistent lymphocoeles using an argon beam coagulator and talc. Aust NZ J Surg 68:743–744
Carrera C, Burgos FJ, Rodriguez R, et al. (1996) Sclerotherapy of post-renal transplantation lymphocele with percutaneous instillation of amidotrizoate. Actas Urol Esp 20:389–394
Ohnishi K, Ohyama N, Ito S, et al. (1988) Prospective randomized controlled trial comparing percutaneous acetic acid injection and percutaneous ethanol injection for small hepatocellular carcinoma. Hepatology 27:67–72
Seo TS, Oh JH, Yoon Y, et al. (2000) Acetic acid as a sclerosing agent for renal cysts: Comparison with ethanol in follow-up results. Cardiovasc Intervent Radiol 23:177–181
Park SW, Cha IH, Kim KA, et al. (2004) Percutaneous sclerotherapy using acetic acid after failure of alcohol ablation in an intra-abdominal lymphangioma. Cardiovasc Intervent Radiol 27:285–287
Won JH, Kim BM, Kim CH, et al. (2004) Percutaneous sclerotherapy of lymphangiomas with acetic acid. J Vasc Intervent Radiol 15:595–600
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Adani, G.L., Baccarani, U., Bresadola, V. et al. Graft Loss Due to Percutaneous Sclerotherapy of a Lymphocele Using Acetic Acid After Renal Transplantation. Cardiovasc Intervent Radiol 28, 836–838 (2005). https://doi.org/10.1007/s00270-005-0002-7
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00270-005-0002-7