POSTTRANSPLANT LYMPHOCELES - A CRITICAL-LOOK INTO THE RISK-FACTORS, PATHOPHYSIOLOGY AND MANAGEMENT

Citation
Rb. Khauli et al., POSTTRANSPLANT LYMPHOCELES - A CRITICAL-LOOK INTO THE RISK-FACTORS, PATHOPHYSIOLOGY AND MANAGEMENT, The Journal of urology, 150(1), 1993, pp. 22-26
Citations number
18
Categorie Soggetti
Urology & Nephrology
Journal title
ISSN journal
00225347
Volume
150
Issue
1
Year of publication
1993
Pages
22 - 26
Database
ISI
SICI code
0022-5347(1993)150:1<22:PL-ACI>2.0.ZU;2-R
Abstract
To define better the prevalence and pathophysiology of lymphoceles fol lowing renal transplantation, we prospectively evaluated 118 consecuti ve renal transplants performed in 115 patients (96 cadaveric, 22 livin g-related, 7 secondary and 111 primary). Ultrasonography was performed post-operatively and during rehospitalizations or whenever complicati ons occurred. Perirenal fluid collections were identified in 43 patien ts (36%). Lymphoceles with a diameter of 5 cm. or greater were identif ied in 26 of 118 cases (22%). Eight patients (6.8%) had symptomatic ly mphoceles requiring therapy. The interval for development of symptomat ic lymphoceles was 1 week to 3.7 years (median 10 months). Risk factor s for the development of lymphoceles were examined by univariate and m ultivariate analysis, and included patient age, sex, source of transpl ants (cadaver versus living-related donor), retransplantation, tissue match (HLA-B/DR), type of preservation, arterial anastomosis, occurren ce of acute tubular necrosis-delayed graft function, occurrence of rej ection, and use of high dose corticosteroids. Univariate analysis show ed a significant risk for the development of lymphoceles in transplant s with acute tubular necrosis-delayed graft function (odds ratio 4.5, p = 0.004), rejection (odds ratio 25.1, p <0.001) and high dose steroi ds (odds ratio 16.4, p <0.001). When applying multivariate analyses us ing stepwise logistic regression, only rejection was associated with a significant risk for lymphoceles (symptomatic lymphoceles-odds ratio 25.08, p = 0.0003, all lymphoceles-odds ratio 75.24, p <0.0001). When adjusting for rejection, no other risk factor came close to being sign ificant (least p = 0.4). Therapy included laparoscopic peritoneal mars upialization and drainage in 1 patient, incisional peritoneal drainage in 4 and percutaneous external drainage in 3 (infected). All symptoma tic lymphoceles were successfully treated without sequelae to grafts o r patients. We conclude that allograft rejection is the most significa nt factor contributing to the development of lymphoceles. Therapy of s ymptomatic lymphoceles should be individualized according to the prese nce or absence of infection.