Is lymphocele in renal transplantation an avoidable complication?

BACKGROUND: This study evaluated the impact of surgery in the incidence of lymphocele after kidney transplantation (KTx). METHODS: A prospective randomized study was conducted during a 6-year perio d on a group of patients undergoing KTx and operated on by the same surgeon (CVS). A total of 280 patients undergoing KTx were randomly allocated into two groups: (1) group C (control group) was 140 patients who were submitte d to KTx with standard technique: implantation of the kidney in the control ateral iliac fossa with vascular anastomoses on the external iliac vessels; and (2) group M (modified technique group) was 140 patients who underwent a modified technique with a cephalad implantation of the graft in the ipsil ateral iliac fossa and vascular anastomoses in the common iliac vessels. Bo th groups were comparable for age, cold ischemia time, incidence of rejecti on episodes, presence of adult polycystic kidney disease, and source of don or graft. RESULTS: Group M showed an incidence of lymphocele production (3 patients, 2.1%) significantly lower than group C (12 patients, 8.5%). Eight patients (1 in group M and 7 in group C) required surgical treatment by peritoneal f enestration. No allograft or recipient was lost as a result of fluid collec tion but the hospitalization was shorter in group M than in group C. CONCLUSIONS: A cephalad implantation of the renal graft in the ipsilateral iliac fossa has been associated with a lower incidence of lymphocele, proba bly because vascular anastomoses on the common iliac vessels cause less lym phatic derangement than those performed on the external iliac vessels. (C) 2000 by Excerpta Medica, Inc.