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
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.