Predictors of symptomatic lymphocele after kidney transplantation

M. Joosten, F.C.H. d' Ancona, W.A.G. van der Meijden, P.P. Poyck

Thursday 14 march 2019

13:29 - 13:31h at Tropentheater

Categories: Klinisch/Basaal, Parallelsessie

Parallel session: Parallelsessie XV – Basaal / Klinisch 2

Background: Symptomatic lymphocele (SL) is a frequent post-operative surgical complication after kidney transplantation. It may lead to pain and discomfort, but can also cause transplant malfunction or even secondary graft loss. We therefore investigated a large cohort for possible risk factors for SL.

Methods: All transplant patients of a single centre were retrospectively analysed for SL between January 2010 and December 2017. SL group was compared with a control group from the same cohort.

Results: 45 out of 1003 transplanted patients developed a SL (incidence 4.5%; 95%CI: 3.6%-5.8%). There was a six-fold higher overall mortality in the SL group (1.5% vs. 8.9%, p=0.000). SL developed more in older patients (48 years vs. 57 years, p=0.017), in those with a PD catheter (14% vs. 22%, p=0.007) and in ADKDP as primary diagnosis (15% vs 31%, p=0.001). Surgical predictors for SL were venous anastomosis on the external iliac vein (5.4% vs. 11%, p=0.021), concomitant PD catheter removal (14% vs. 18%, p=0.014), perfusion defects (7.3% vs. 20%, p=0.000), longer operating time (165min ± 0:41 vs. 156min ± 0:33, p=0.012), splint >7 days (0.6% vs. 2.2%, p=0.009), JJ stenting (11% vs. 22%, p=0.000), drain requirement at discharge (1.3% vs. 6.7%, p=0.000), low initial drain production (359ml ± 533ml vs. 147ml ± 188ml, p=0.011) and ureteral obstruction (4.2% vs. 18%, p=0.000). Opening the peritoneum (6.4% vs. 0%, p=0,000), re-operation for post-operative bleeding (2.5% vs. 0%, p=0.03) and previous nephrectomy (10% vs 0%, p=0.03) seem protective for developing SL.

Conclusions: Despite finding multiple heterogeneous predictors for SL, a common denominator relate to surgical management of the retro-peritoneal space and the ureter. Hopefully, this will lead to measures that can prevent SL from developing.