MANAGEMENT OF LYMPHOCELES AFTER KIDNEY-TRANSPLANTATION

Post-transplant lymphoceles (LC) may lead to impaired graft function. Treatment modalities include fine-needle aspiration, percutaneous drai nage, and surgical internal drainage. Recently, laparoscopic fenestrat ion has been performed with good results, but experience is still limi ted. Between January 1991 and August 1996, 919 kidney transplantations were performed in 876 patients at our department. There were 745 firs t, 133 second, 30 third, 9 fourth, and 2 fifth operations. Sixty-three symptomatic LCs were detected in 62 patients (6.8 %) after 39 +/- 31 days. In 44 % of the cases, graft function was impaired; in 29 % hydro nephrosis was documented and in 6 % infection of the LC. Forty-five of the 62 patients with LC (73 %) had histologically proven rejection. T hirty-five of the 63 LCs were drained percutaneously, 20 LCs were inte rnally drained by open surgery, and 8 LCs were drained by laparoscopy. In 14 of the 47 patients (30 %) with primary percutaneous drainage, L C recurred; infection occurred in 17 %. Twelve of these patients under went surgery. One surgical redrainage was necessary after open fenestr ation. No conversion or complication was noted in the laparoscopy grou p. We conclude that surgery for posttransplant lymphoceles is safe and effective. We favor the laparoscopic technique in selected patients.