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Yamanaka K, Kakuta Y, Nakazawa S, Kobayashi K, Nonomura N, Kageyama S. Surgical and Infectious Complications Following Kidney Transplantation: A Contemporary Review. J Clin Med 2025; 14:3307. [PMID: 40429301 PMCID: PMC12112604 DOI: 10.3390/jcm14103307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2025] [Revised: 04/24/2025] [Accepted: 05/02/2025] [Indexed: 05/29/2025] Open
Abstract
Kidney transplantation significantly improves outcomes in patients with end-stage renal disease; however, postoperative complications remain a substantial concern. This review summarizes the incidence, risk factors, and management strategies for common complications after kidney transplantation. Reported incidence varies widely due to differences in definitions, diagnostic methods, and study designs. Ureteral stenosis occurs in 2.8-18.0% of recipients, vesicoureteral reflux in 0.5-86%, and urinary leakage in 1.1-7.2%. Lymphatic complications, including lymphocele and lymphorrhea, range from 0.6% to 35.2%, with one-third of complications requiring intervention. The incidence of urinary tract infections ranges from 20 to 43%, while asymptomatic bacteriuria is reported in up to 53% of recipients. Surgical site infections have a median incidence of 3.7%, and incisional hernias develop in 2.5-10% of cases, depending on follow-up duration. Vascular complications affect approximately 10% of recipients, with renal artery stenosis and thrombosis being the most prevalent. Neurologic complications, such as femoral nerve palsy and immunosuppression-related neurotoxicity, though less frequent, can impair recovery. Management strategies vary depending on severity, ranging from observation to surgical intervention. Preventive measures-including optimized ureteral stenting protocols, early catheter removal, careful immunosuppression, and appropriate antimicrobial use-play a crucial role in reducing complication risk. Despite advances in transplantation techniques and perioperative care, these complications continue to affect graft survival and patient outcomes. Further research is needed to standardize definitions and establish evidence-based protocols.
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Affiliation(s)
- Kazuaki Yamanaka
- Department of Urology, Shiga University of Medical Science, Otsu 520-2192, Japan; (K.K.); (S.K.)
- Department of Urology, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan; (Y.K.); (S.N.); (N.N.)
| | - Yoichi Kakuta
- Department of Urology, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan; (Y.K.); (S.N.); (N.N.)
| | - Shigeaki Nakazawa
- Department of Urology, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan; (Y.K.); (S.N.); (N.N.)
| | - Kenichi Kobayashi
- Department of Urology, Shiga University of Medical Science, Otsu 520-2192, Japan; (K.K.); (S.K.)
| | - Norio Nonomura
- Department of Urology, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan; (Y.K.); (S.N.); (N.N.)
| | - Susumu Kageyama
- Department of Urology, Shiga University of Medical Science, Otsu 520-2192, Japan; (K.K.); (S.K.)
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Sabagh M, Weber S, Sabetkish N, Ramouz A, Fakour S, Morath C, Mieth M, Zeier M, Khajeh E, Mehrabi A, Golriz M. Modified Peritoneal Fenestration as a Preventive Method for Lymphocele after Kidney Transplantation: A Preliminary Report. J Clin Med 2024; 13:5878. [PMID: 39407938 PMCID: PMC11477912 DOI: 10.3390/jcm13195878] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Revised: 09/23/2024] [Accepted: 09/28/2024] [Indexed: 10/20/2024] Open
Abstract
Background: We aimed to assess the safety of a modified peritoneal fenestration technique with clipping of the window edges during kidney transplantation (KTx) and to determine its impact on reducing lymphocele following KTx. We compared the outcomes of this modified method with those of peritoneal fenestration without clipping. Methods: Among 430 consecutive KTxs performed between 2015 and 2019, preventive peritoneal fenestration and clipping of the margins were performed in 25 patients. These patients were compared with 75 matched patients in whom the margins were not clipped. Postoperative lymphocele formation and other patient data were compared between these two groups. Results: The rate of clinically relevant lymphocele decreased by 2.7% after peritoneal fenestration with clipping, although this decrease was not statistically significant (p = 0.829). There was no significant increase in the rate of other complications in the modified fenestration group (p = 0.067). The incidence of clinically significant lymphocele formation was notably higher in patients with a body mass index greater than 25 kg/m2 (p = 0.028). Univariate analysis indicated that older recipients, individuals with a history of previous abdominal surgery, those receiving the kidney from deceased and older donors were at increased risk of developing a clinically relevant lymphocele. Conclusions: Our preliminary results suggest that peritoneal fenestration with clipping may be as effective as the conventional fenestration technique in preventing lymphocele formation. Further clinical trials with larger sample sizes are required to determine the exact role of preventive peritoneal fenestration with clipping in preventing clinically relevant lymphocele after KTx.
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Affiliation(s)
- Mohammadsadegh Sabagh
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, 69120 Heidelberg, Germany; (M.S.); (N.S.); (A.R.); (S.F.); (M.M.); (E.K.); (A.M.)
| | - Sanaz Weber
- Department of Anesthesiology, Heidelberg University Hospital, 69120 Heidelberg, Germany;
| | - Nastaran Sabetkish
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, 69120 Heidelberg, Germany; (M.S.); (N.S.); (A.R.); (S.F.); (M.M.); (E.K.); (A.M.)
| | - Ali Ramouz
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, 69120 Heidelberg, Germany; (M.S.); (N.S.); (A.R.); (S.F.); (M.M.); (E.K.); (A.M.)
| | - Sanam Fakour
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, 69120 Heidelberg, Germany; (M.S.); (N.S.); (A.R.); (S.F.); (M.M.); (E.K.); (A.M.)
| | - Christian Morath
- Department of Nephrology, Heidelberg University Hospital, 69120 Heidelberg, Germany; (C.M.); (M.Z.)
| | - Markus Mieth
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, 69120 Heidelberg, Germany; (M.S.); (N.S.); (A.R.); (S.F.); (M.M.); (E.K.); (A.M.)
| | - Martin Zeier
- Department of Nephrology, Heidelberg University Hospital, 69120 Heidelberg, Germany; (C.M.); (M.Z.)
| | - Elias Khajeh
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, 69120 Heidelberg, Germany; (M.S.); (N.S.); (A.R.); (S.F.); (M.M.); (E.K.); (A.M.)
| | - Arianeb Mehrabi
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, 69120 Heidelberg, Germany; (M.S.); (N.S.); (A.R.); (S.F.); (M.M.); (E.K.); (A.M.)
| | - Mohammad Golriz
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, 69120 Heidelberg, Germany; (M.S.); (N.S.); (A.R.); (S.F.); (M.M.); (E.K.); (A.M.)
- Department of General and Visceral Surgery, Diakonie Clinic Jung-Stilling, Wichernstraße 40, 57074 Siegen, Germany
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Takahashi H, Inoue A, Tanaka T, Sato Y, Potretzke TA, Masuoka S, Takahashi N, Minami M, Kawashima A. Imaging of Perirenal and Intrarenal Lymphatic Vessels: Anatomy-based Approach. Radiographics 2024; 44:e230065. [PMID: 38386603 DOI: 10.1148/rg.230065] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
The lymphatic system (or lymphatics) consists of lymphoid organs and lymphatic vessels. Despite the numerous previously published studies describing conditions related to perirenal and intrarenal lymphoid organs in the radiology literature, the radiologic findings of conditions related to intrarenal and perirenal lymphatic vessels have been scarcely reported. In the renal cortex, interlobular lymphatic capillaries do not have valves; therefore, lymph can travel along the primary route toward the hilum, as well as toward the capsular lymphatic plexus. These two lymphatic pathways can be opacified by contrast medium via pyelolymphatic backflow at CT urography, which reflects urinary contrast agent leakage into perirenal lymphatic vessels via forniceal rupture. Pyelolymphatic backflow toward the renal hilum should be distinguished from urinary leakage due to urinary injury. Delayed subcapsular contrast material retention via pyelolymphatic backflow, appearing as hyperattenuating subcapsular foci on CT images, mimics other subcapsular cystic diseases. In contrast to renal parapelvic cysts originating from the renal parenchyma, renal peripelvic cysts are known to be of lymphatic origin. Congenital renal lymphangiectasia is mainly seen in children and assessed and followed up at imaging. Several lymphatic conditions, including lymphatic leakage as an early complication and acquired renal lymphangiectasia as a late complication, are sometimes identified at imaging follow-up of kidney transplant. Lymphangiographic contrast material accumulation in the renal hilar lymphatic vessels is characteristic of chylo-urinary fistula. Chyluria appears as a fat-layering fluid-fluid level in the urinary bladder or upper urinary tract. Recognition of the anatomic pathway of tumor spread via lymphatic vessels at imaging is of clinical importance for accurate management at oncologic imaging. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.
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Affiliation(s)
- Hiroaki Takahashi
- From the Department of Radiology (H.T., A.I., T.A.P., N.T.) and Department of Medicine, Division of Rheumatology (Y.S.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Radiology, Okayama City Hospital, Okayama, Japan (T.T.); Department of Radiology, Jichi Medical University, Tochigi, Japan (S.M.); Department of Diagnostic and Interventional Radiology, University of Tsukuba, Ibaraki, Japan (M.M.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (A.K.)
| | - Akitoshi Inoue
- From the Department of Radiology (H.T., A.I., T.A.P., N.T.) and Department of Medicine, Division of Rheumatology (Y.S.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Radiology, Okayama City Hospital, Okayama, Japan (T.T.); Department of Radiology, Jichi Medical University, Tochigi, Japan (S.M.); Department of Diagnostic and Interventional Radiology, University of Tsukuba, Ibaraki, Japan (M.M.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (A.K.)
| | - Takashi Tanaka
- From the Department of Radiology (H.T., A.I., T.A.P., N.T.) and Department of Medicine, Division of Rheumatology (Y.S.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Radiology, Okayama City Hospital, Okayama, Japan (T.T.); Department of Radiology, Jichi Medical University, Tochigi, Japan (S.M.); Department of Diagnostic and Interventional Radiology, University of Tsukuba, Ibaraki, Japan (M.M.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (A.K.)
| | - Yuki Sato
- From the Department of Radiology (H.T., A.I., T.A.P., N.T.) and Department of Medicine, Division of Rheumatology (Y.S.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Radiology, Okayama City Hospital, Okayama, Japan (T.T.); Department of Radiology, Jichi Medical University, Tochigi, Japan (S.M.); Department of Diagnostic and Interventional Radiology, University of Tsukuba, Ibaraki, Japan (M.M.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (A.K.)
| | - Theodora A Potretzke
- From the Department of Radiology (H.T., A.I., T.A.P., N.T.) and Department of Medicine, Division of Rheumatology (Y.S.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Radiology, Okayama City Hospital, Okayama, Japan (T.T.); Department of Radiology, Jichi Medical University, Tochigi, Japan (S.M.); Department of Diagnostic and Interventional Radiology, University of Tsukuba, Ibaraki, Japan (M.M.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (A.K.)
| | - Sota Masuoka
- From the Department of Radiology (H.T., A.I., T.A.P., N.T.) and Department of Medicine, Division of Rheumatology (Y.S.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Radiology, Okayama City Hospital, Okayama, Japan (T.T.); Department of Radiology, Jichi Medical University, Tochigi, Japan (S.M.); Department of Diagnostic and Interventional Radiology, University of Tsukuba, Ibaraki, Japan (M.M.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (A.K.)
| | - Naoki Takahashi
- From the Department of Radiology (H.T., A.I., T.A.P., N.T.) and Department of Medicine, Division of Rheumatology (Y.S.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Radiology, Okayama City Hospital, Okayama, Japan (T.T.); Department of Radiology, Jichi Medical University, Tochigi, Japan (S.M.); Department of Diagnostic and Interventional Radiology, University of Tsukuba, Ibaraki, Japan (M.M.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (A.K.)
| | - Manabu Minami
- From the Department of Radiology (H.T., A.I., T.A.P., N.T.) and Department of Medicine, Division of Rheumatology (Y.S.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Radiology, Okayama City Hospital, Okayama, Japan (T.T.); Department of Radiology, Jichi Medical University, Tochigi, Japan (S.M.); Department of Diagnostic and Interventional Radiology, University of Tsukuba, Ibaraki, Japan (M.M.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (A.K.)
| | - Akira Kawashima
- From the Department of Radiology (H.T., A.I., T.A.P., N.T.) and Department of Medicine, Division of Rheumatology (Y.S.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Radiology, Okayama City Hospital, Okayama, Japan (T.T.); Department of Radiology, Jichi Medical University, Tochigi, Japan (S.M.); Department of Diagnostic and Interventional Radiology, University of Tsukuba, Ibaraki, Japan (M.M.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (A.K.)
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Serirodom M, Taweemonkongsap T, Chotikawanich E, Jitpraphai S, Woranisarakul V, Shrestha S, Hansomwong T. Lymphocele in Kidney Transplantation: A Comparison of Ligation and Non-ligation Technique of Iliac Lymphatic Dissection. Transplant Proc 2022; 54:2197-2204. [PMID: 36163083 DOI: 10.1016/j.transproceed.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 07/03/2022] [Accepted: 07/14/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND To compare the incidence of lymphocele in kidney recipients following 2 lymphatic vessel division techniques: ligation and non-ligation. METHODS Retrospective reviews of the records of 402 patients with end-stage renal disease who underwent kidney transplantation from April 2015 to December 2019 at Siriraj Hospital. RESULTS Four hundred two patients were included in the study: 54.9% of the patients were male, and the patient's mean age was 41 years. There were 25.1% and 74.9% that received kidney grafts from living and deceased donors, respectively. The preoperative renal replacement therapies were 83.3% hemodialysis, 12.9% peritoneal dialysis, and 3.7% preemptive transplantation. Two hundred forty-nine patients received lymphatic division with the ligation technique and 153 patients received the non-ligation. Lymphoceles were found in 31 cases (7.7%). Lymphocele occurrence in the ligation group was lower than in the non-ligation group: 5.2% compared to 11.8% (P value = .017). There were 22.6% of lymphoceles that had a spontaneous resolution with no treatment. DISCUSSION The ligation of iliac lymphatic vessels during division reduced the incidence of lymphoceles non-ligation.
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Affiliation(s)
- M Serirodom
- Division of Urology, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - T Taweemonkongsap
- Division of Urology, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - E Chotikawanich
- Division of Urology, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - S Jitpraphai
- Division of Urology, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - V Woranisarakul
- Division of Urology, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - S Shrestha
- Department of Surgery, Pokhara Academy of Health Sciences, Nepal
| | - T Hansomwong
- Division of Urology, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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Prophylactic Peritoneal Fenestration during Kidney Transplantation Can Reduce the Type C Lymphocele Formation. J Clin Med 2021; 10:jcm10235651. [PMID: 34884352 PMCID: PMC8658067 DOI: 10.3390/jcm10235651] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 11/22/2021] [Accepted: 11/29/2021] [Indexed: 12/02/2022] Open
Abstract
Lymphocele is a common complication following kidney transplantation (KTx). We aimed to evaluate the preventive effect of peritoneal fenestration during KTx in reducing lymphocele. From January 2001, the data of all KTx were prospectively gathered in our digital data bank. From 2008, preventive peritoneal fenestration was performed as a routine procedure for all patients with KTx. Between 2001 and 2008, 579 KTx were performed without preventive peritoneal fenestration. To compare the results between with and without peritoneal fenestration, the same number of patients after 2008 (579 patients) was included in this study. The pre-, intra-, and postoperative data of the patients in these two groups were analyzed and compared, especially regarding the postoperative different types of lymphocele formation. The mean recipient age was 52.6 ± 13.8, and 33.7% of the patients were female. Type C lymphocele was significantly lower in the group with preventive fenestration (5.3% vs. 8.8%, p = 0.014 for 31/579 vs. 51/579). Peritoneal dialysis and implantation of the kidney in the left fossa were independently associated with a higher rate of type C lymphocele (OR 2.842, 95% CI 1.354–5.967, p = 0.006 and OR 3.614, 95% CI 1.215–10.747, p = 0.021, respectively). The results of this study showed that intraoperative preventive peritoneal fenestration could significantly reduce type C lymphocele.
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Validating Consensus-Defined Severity Grading of Lymphatic Complications after Kidney Transplant. J Clin Med 2021; 10:jcm10214858. [PMID: 34768377 PMCID: PMC8584504 DOI: 10.3390/jcm10214858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 10/15/2021] [Accepted: 10/19/2021] [Indexed: 11/17/2022] Open
Abstract
Lymphatic complications after kidney transplantation (KTx) are associated with morbidities such as impaired wound healing, thrombosis, and organ failure. Recently, a consensus regarding the definition and severity grading of lymphoceles has been suggested. The aim of the present study was to validate this classification method. All adult patients who underwent KTx between December 2011 and September 2016 in our department were evaluated regarding lymphoceles that were diagnosed within 6 months after KTx based on the recent definition. Patients with lymphoceles were categorized according to the classification criteria, and clinical outcomes were compared between the groups. In our department, a total of 587 patients underwent KTx between 2011 and 2016. Lymphoceles were detected after KTx in 90 patients (15.3%). Among these patients, 24 (26.6%) had grade A lymphoceles, 14 (15.6%) had grade B, and 52 (57.8%) had grade C. The median duration times of intermediate care (IMC) and hospital stay were significantly higher among patients with grade C lymphoceles than they were among patients with grade A and B lymphoceles. Significantly more patients with grade C lymphoceles were readmitted to the hospital for treatment. The recently published definition and severity grading of lymphoceles after KTx is an easy-to-use and valid classification system, which may facilitate the comparison of results from different studies on lymphoceles after KTx.
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Sigdel PR, Gnyawali D, Thapa J, Rai BDK, Dhital P, Parajuli P, Chudal S, Pradhan M, Poudyal S, Chapagain S, Luitel BR, Chalise PR, Gyawali PR, Sharma UK. Bipolar vessel sealing system versus silk ligation of lymphatic vessels in renal transplant recipient lymphatic complications: a randomized controlled trial. Int Urol Nephrol 2021; 53:2477-2483. [PMID: 34655393 DOI: 10.1007/s11255-021-03003-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 09/24/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE This study was aimed to compare lymphatic complications of bipolar vessel sealing system with silk ligation of lymphatic vessels among renal transplant recipients. METHODS This was a prospective randomized controlled trial done among 68 patients undergoing renal transplantation in Tribhuvan University Teaching Hospital. They were randomly assigned to either silk ligation or Enseal bipolar vessel sealing lymphatic dissection. Postoperative drain volume and duration of drain placement were measured in all patients. Ultrasound was used to find lymphocele formation in six and 12 weeks. RESULTS Total of 30 patients in silk ligation group and 28 patients in bipolar vessel sealing group were analyzed. The baseline characteristics of the patients in each group were similar. Overall, lymphatic complications (either lymphorrhea or lymphocele formation) were in 16 cases (27.58%), 7 (25%) in the bipolar group, and 9 (30%) in the silk ligation group (p = 0.67). A total of 13 patients (22.41%) had lymphorrhea, 6 (21.4%) patients in the bipolar group, and 7 (23.3%) patients in the silk ligation group. Median drain volume was 415 ml (Q1 275 ml, Q3 675 ml) in the bipolar group and 542 ml (Q1 290, Q3 775) in silk group (p = 0.72). Median drain removal day was 5 in each bipolar and silk group with Q1 and Q3 being 5 days in each arm (p = 0.95). A total of five patients (8.62%) developed symptomatic lymphocele, two (7.1%) in the bipolar group, and three (10%) in the silk ligation group, but the difference was not statistically significant. In univariate analysis, double renal arteries in the donor's kidney (p = 0.03) and graft rejection (p = 0.04) were risk factors for the development of lymphatic complications. However, in multivariable analysis, these factors were not statistically significant. CONCLUSIONS This study did not find any significant differences in lymphatic complications between bipolar vessel sealing system and silk ligation. However, large sample multi-centric studies should be done to add evidences on lymphatic complications differences between these two techniques. TRIAL REGISTRATION NUMBER UMIN000039354, Date of registration-2020, Feb 01.
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Affiliation(s)
- Prem Raj Sigdel
- Department of Urology and Kidney Transplant Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal.
| | - Diwas Gnyawali
- Department of Urology and Kidney Transplant Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Jeevan Thapa
- Department of Community Health Sciences, Patan Academy of Health Sciences, Patan, Nepal
| | - Bipendra D K Rai
- Department of Urology and Kidney Transplant Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Pawan Dhital
- Department of Urology and Kidney Transplant Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Purushottam Parajuli
- Department of Urology and Kidney Transplant Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Sampanna Chudal
- Department of Urology and Kidney Transplant Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Manish Pradhan
- Department of Urology and Kidney Transplant Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Sujeet Poudyal
- Department of Urology and Kidney Transplant Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Suman Chapagain
- Department of Urology and Kidney Transplant Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Bhoj R Luitel
- Department of Urology and Kidney Transplant Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Pawan R Chalise
- Department of Urology and Kidney Transplant Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Prem R Gyawali
- Department of Urology and Kidney Transplant Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Uttam K Sharma
- Department of Urology and Kidney Transplant Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
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Agarwal N, Kumar GR, Singh Rana AK, Mubeen A, Dokania MK. Predictors of Lymphatic Complications Following Renal Transplant: A Prospective Study Involving Predominantly Living Donor Transplants From India. Cureus 2021; 13:e17133. [PMID: 34532172 PMCID: PMC8437002 DOI: 10.7759/cureus.17133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction Lymphatic complications (LC) are common (up to 33%) and troublesome after renal transplantation. Different studies have established varying medical and surgical risk factors, mostly by retrospective analysis on deceased donor renal transplants (DDRTs). The end-point is mostly lymphocele, with few reports documenting the equally important lymphorrhea. Methods In our prospective analytical study done over three years, most were living donor renal transplant (LDRT) pairs by a single team. The primary outcome measure was lymphocele and/or prolonged drainage for more than 15 days, with a six-month follow-up. The variables recorded were age, gender, hemodialysis duration, etiology, relationship, human leucocyte antigen (HLA) mismatch, induction regimen, acute rejection, warm ischemia time (WIT), and delayed graft function (DGF). Univariate analysis was by chi-square and t-tests as applicable, while logistic regression (both simultaneous and forward stepwise) was used for risk factor prediction. Results Eligible cases were 150, with 145 (97%) LDRT pairs. Donors were mostly female (122/150; 81%) with mean age (~43 years) higher than recipient age (~33 years). The common etiologies were diabetes (31%), hypertension (23%), and IgA nephropathy (11%). Most donors were mothers (37%) and wives (31%), and 28% of LDRT pairs had HLA mismatch >3. Mean duration of hemodialysis was about 18 months, and mean WIT was 52 minutes. Both DGF (B coefficient= -1.69, p<0.000) and WIT (B=-0.038, p=0.024) were significant predictors of the primary outcome, while drain removal before 15 days predicted lymphocele significantly (B=-2.4, p<0.000). Conclusions LDRT has specific risk factors for lymphatic complications, which may be related to extent of recipient vascular dissection, arterial anastomotic time, and early drain removal.
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Affiliation(s)
- Nitin Agarwal
- Transplant Unit, Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences and Ram Manohar Lohia Hospital, Delhi, IND
| | - Gyan R Kumar
- Transplant Unit, Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences and Ram Manohar Lohia Hospital, Delhi, IND
| | - Anil K Singh Rana
- Transplant Unit, Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences and Ram Manohar Lohia Hospital, Delhi, IND
| | - Abdul Mubeen
- Transplant Unit, Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences and Ram Manohar Lohia Hospital, Delhi, IND
| | - Manoj K Dokania
- Transplant Unit, Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences and Ram Manohar Lohia Hospital, Delhi, IND
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Risk Factors, Diagnosis, and Treatment of Lymphocele After Renal Transplantation: A Retrospective Study. Transplant Proc 2021; 53:1040-1047. [PMID: 33573817 DOI: 10.1016/j.transproceed.2021.01.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 11/23/2020] [Accepted: 01/08/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Despite recent advances, lymphoceles are the most frequent complications following renal transplantation (RT), with an incidence of 0.6% to 51%. In this study, we present risk factors, treatments, and outcomes for lymphoceles after RT at our center. MATERIAL AND METHODS Since January 2018, 461 RTs were performed at our center. Nine recipients were excluded. The remaining 452 RTs were analyzed retrospectively. Recipients were divided into 2 groups: a lymphocele group (n = 29) and a nonlymphocele group (n = 423). Lymphoceles were diagnosed by ultrasound. Statistical analyses were made using the SPSS 15 software program. RESULTS Twenty-nine (6.4%) of the 452 recipients developed lymphoceles. Seven of these 29 (24.1%) recipients were asymptomatic. The most common symptom was hydronephrosis (34.4%). Percutaneous drainage was performed in 21 recipients; sclerotherapy with percutaneous drainage was used in the remaining 8. In 5 (17.2%) recipients, there was a recurrence of lymphoceles. There were significant differences with respect to age (50-65 years; P = .016), use of a drainage catheter (P = .044), and polycystic kidney diseases (P = .049). CONCLUSION Lymphoceles can be treated successfully using the percutaneous drainage technique alone or in combination with povidone iodine. Drainage use, polycystic kidney disease, and age (50-65 years) were established as risk factors for lymphocele development.
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Analysis of Risk Factors and Long-Term Outcomes in Kidney Transplant Patients with Identified Lymphoceles. J Clin Med 2020; 9:jcm9092841. [PMID: 32887366 PMCID: PMC7563120 DOI: 10.3390/jcm9092841] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/24/2020] [Accepted: 08/29/2020] [Indexed: 11/22/2022] Open
Abstract
The collection of lymphatic fluids (lymphoceles) is a frequent adverse event following renal transplantation. A variety of surgical and medical factors has been linked to this entity, but reliable data on risk factors and long-term outcomes are lacking. This retrospective single-center study included 867 adult transplant recipients who received a kidney transplantation from 2006 to 2015. We evaluated for patient and graft survival, rejection episodes, or detectable donor-specific antibodies (dnDSA) in patients with identified lymphoceles in comparison to controls. We identified 305/867 (35.2%) patients with lymphocele formation, of whom 72/867 (8.3%) needed intervention. Multivariate analysis identified rejection episode as an independent risk factor (OR 1.61, CI 95% 1.17–2.21, p = 0.003) for lymphocele formation, while delayed graft function was independently associated with symptomatic lymphoceles (OR 1.9, CI 95% 1.16–3.12, p = 0.011). Interestingly, there was no difference in detectable dnDSA between groups with a similar graft and patient survival in all groups after 10 years. Lymphoceles frequently occur after transplantation and were found to be independently associated with rejection episodes, while symptomatic lymphoceles were associated with delayed graft function in our cohort. As both are inflammatory processes, they might play a causative role in the formation of lymphoceles. However, development or intervention of lymphoceles did not lead to impaired graft survival in the long-term.
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Roberts S, Alluri R, Licari HH, Choi JT, Wang JC, Hah RJ. A Case Series of Retroperitoneal Lymphocele Following Anterior Lumbar Interbody Fusion. World Neurosurg 2020; 140:114-118. [DOI: 10.1016/j.wneu.2020.04.234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/28/2020] [Accepted: 04/29/2020] [Indexed: 11/29/2022]
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12
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Mehrabi A, Kulu Y, Sabagh M, Khajeh E, Mohammadi S, Ghamarnejad O, Golriz M, Morath C, Bechstein WO, Berlakovich GA, Demartines N, Duran M, Fischer L, Gürke L, Klempnauer J, Königsrainer A, Lang H, Neumann UP, Pascher A, Paul A, Pisarski P, Pratschke J, Schneeberger S, Settmacher U, Viebahn R, Wirth M, Wullich B, Zeier M, Büchler MW. Consensus on definition and severity grading of lymphatic complications after kidney transplantation. Br J Surg 2020; 107:801-811. [PMID: 32227483 DOI: 10.1002/bjs.11587] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/23/2020] [Accepted: 02/14/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND The incidence of lymphatic complications after kidney transplantation varies considerably in the literature. This is partly because a universally accepted definition has not been established. This study aimed to propose an acceptable definition and severity grading system for lymphatic complications based on their management strategy. METHODS Relevant literature published in MEDLINE and Web of Science was searched systematically. A consensus for definition and a severity grading was then sought between 20 high-volume transplant centres. RESULTS Lymphorrhoea/lymphocele was defined in 32 of 87 included studies. Sixty-three articles explained how lymphatic complications were managed, but none graded their severity. The proposed definition of lymphorrhoea was leakage of more than 50 ml fluid (not urine, blood or pus) per day from the drain, or the drain site after removal of the drain, for more than 1 week after kidney transplantation. The proposed definition of lymphocele was a fluid collection of any size near to the transplanted kidney, after urinoma, haematoma and abscess have been excluded. Grade A lymphatic complications have a minor and/or non-invasive impact on the clinical management of the patient; grade B complications require non-surgical intervention; and grade C complications require invasive surgical intervention. CONCLUSION A clear definition and severity grading for lymphatic complications after kidney transplantation was agreed. The proposed definitions should allow better comparisons between studies.
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Affiliation(s)
- A Mehrabi
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Y Kulu
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - M Sabagh
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - E Khajeh
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - S Mohammadi
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - O Ghamarnejad
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - M Golriz
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - C Morath
- Division of Nephrology, Heidelberg University Hospital, Heidelberg, Germany
| | - W O Bechstein
- Department of General and Visceral Surgery, Frankfurt University Hospital, Goethe University, Frankfurt am Main, Germany
| | - G A Berlakovich
- Division of Transplantation, Department of Surgery, Vienna Medical University, Vienna, Austria
| | - N Demartines
- Department of Visceral Surgery, CHUV University Hospital, Lausanne, Switzerland
| | - M Duran
- Department of Vascular and Endovascular Surgery, Düsseldorf University Hospital, Heinrich-Heine-University, Düsseldorf, Germany
| | - L Fischer
- Department of Visceral and Transplantation Surgery, Hamburg-Eppendorf University Hospital, Hamburg, Germany
| | - L Gürke
- Department of Vascular and Transplantation Surgery, Basel University Hospital, Basel, Switzerland
| | - J Klempnauer
- Department of General, Visceral, and Transplantation Surgery, Hannover Medical University, Hannover, Germany
| | - A Königsrainer
- Department of General, Visceral and Transplantation Surgery, Eberhard-Karls-University Hospital, Tübingen, Germany
| | - H Lang
- Department of General, Visceral and Transplantation Surgery, Johannes Gutenberg Medical University, Mainz, Germany
| | - U P Neumann
- Department of General, Visceral and Transplantation Surgery, RWTH University Hospital, Aachen, Germany
| | - A Pascher
- Department of General, Visceral and Transplantation Surgery, Münster University Hospital, Münster, Germany
| | - A Paul
- Department of General, Visceral and Transplantation Surgery, Essen University Hospital, Essen, Germany
| | - P Pisarski
- Department of General, Visceral and Surgery, Freiburg University Hospital, Freiburg, Germany
| | - J Pratschke
- Department of Surgery, Charité University Hospital, Berlin, Germany
| | - S Schneeberger
- Department of Visceral, Transplantation and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - U Settmacher
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Jena, Germany
| | - R Viebahn
- Department of Surgery, Knappschaftskrankenhaus University Hospital of Bochum, Ruhr University of Bochum, Bochum, Germany
| | - M Wirth
- Department of Urology, Carl Gustav Carus University Hospital, Dresden, Germany
| | - B Wullich
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Erlangen, Germany
| | - M Zeier
- Division of Nephrology, Heidelberg University Hospital, Heidelberg, Germany
| | - M W Büchler
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
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Gatz JD, Spangler R. Evaluation of the Renal Transplant Recipient in the Emergency Department. Emerg Med Clin North Am 2019; 37:679-705. [PMID: 31563202 DOI: 10.1016/j.emc.2019.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Renal transplants are becoming more and more frequent in the United States and worldwide. Studies demonstrate that these patients inevitably end up visiting an emergency department. In addition to typical medical and surgical problems encountered in the general population, this group of patients has unique problems arising from their immunocompromised state and also due to side effects of the medications required. This article discusses these risks and management decisions that the emergency department physician should be aware of in order to prevent adverse outcomes for the patient and transplanted kidney.
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Affiliation(s)
- John David Gatz
- Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street, Sixth Floor, Suite 200, Baltimore, MD 21201, USA
| | - Ryan Spangler
- Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street, Sixth Floor, Suite 200, Baltimore, MD 21201, USA.
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Cayetano-Alcaraz A, Rodriguez-Alvarez JS, Vilatobá-Chapa M, Alberú-Gómez J, Gabilondo-Pliego B, Rodríguez-Covarrubias F, Morales-Buenrostro LE, Méndez-Probst CE. Is delayed graft function associated with ureteral stenosis in the kidney transplant recipient? A case-control study. Can Urol Assoc J 2019; 13:E361-E365. [PMID: 30817285 DOI: 10.5489/cuaj.5794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Ureteral stricture (US) in the kidney transplant recipient is a rare complication that can lead to morbidity and graft loss. Risk factor recognition is crucial in the prevention and management of this entity. Delayed graft function (DGF), as defined by the need for dialysis in the first week after transplantation, has been proposed as a risk factor in previous studies. Our objective is to determine the impact of DGF in US development in kidney transplant patients. METHODS We designed a matched case-control study. US cases in kidney transplant recipients were identified in the 2008-2017 period. We defined US as the rise in serum creatinine associated with findings suggesting obstruction in ultrasound, scintigraphy, or retrograde pyelogram; any other cause of graft dysfunction was excluded. Controls were defined as kidney transplant recipients from the same population and period without US, matched in a 1:2 fashion by age, sex, and donor type. RESULTS From 532 kidney transplant patients, 31 cases and 62 controls were included. Cumulative US incidence was 58 per 1000 cases. When calculating for odds ratio (OR), post-operative urinoma (OR 3.2; 95% confidence interval [CI] 2.36-4.37) and ureteral duplication (OR 3.29; 95% CI 2.40-4.51) were associated with an increased risk for US, while DGF was not found to be statistically significant as a risk factor (OR 3.3; 95% CI 0.96-11.52). No statistically significant differences were found between groups in other pre- and post-transplant-related factors CONCLUSIONS:: DGF was not associated with US in our cohort; however, ureteral duplication and postoperative urinoma were associated with an increased risk of graft ureteral stenosis development.
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Affiliation(s)
- Axel Cayetano-Alcaraz
- Department of Urology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Mario Vilatobá-Chapa
- Department of Transplants, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Josefina Alberú-Gómez
- Department of Transplants, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Bernardo Gabilondo-Pliego
- Department of Urology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Heer MK, Clark D, Trevillian PR, Sprott P, Palazzi K, Hibberd AD. Functional significance and risk factors for lymphocele formation after renal transplantation. ANZ J Surg 2017; 88:597-602. [DOI: 10.1111/ans.14343] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 11/08/2017] [Accepted: 11/13/2017] [Indexed: 01/23/2023]
Affiliation(s)
- Munish K. Heer
- Newcastle Transplant Unit; John Hunter Hospital; Newcastle New South Wales Australia
- The University of Newcastle; Newcastle New South Wales Australia
- Hunter Transplant Research Foundation; Newcastle New South Wales Australia
| | - David Clark
- Newcastle Transplant Unit; John Hunter Hospital; Newcastle New South Wales Australia
- The University of Newcastle; Newcastle New South Wales Australia
| | - Paul R. Trevillian
- Newcastle Transplant Unit; John Hunter Hospital; Newcastle New South Wales Australia
- The University of Newcastle; Newcastle New South Wales Australia
- Hunter Transplant Research Foundation; Newcastle New South Wales Australia
- Hunter Medical Research Institute; Newcastle New South Wales Australia
| | - Philip Sprott
- Newcastle Transplant Unit; John Hunter Hospital; Newcastle New South Wales Australia
- The University of Newcastle; Newcastle New South Wales Australia
| | - Kerrin Palazzi
- Hunter Medical Research Institute; Newcastle New South Wales Australia
| | - Adrian D. Hibberd
- Newcastle Transplant Unit; John Hunter Hospital; Newcastle New South Wales Australia
- The University of Newcastle; Newcastle New South Wales Australia
- Hunter Transplant Research Foundation; Newcastle New South Wales Australia
- Hunter Medical Research Institute; Newcastle New South Wales Australia
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16
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Prevention and management of lymphocele formation following kidney transplantation. Transplant Rev (Orlando) 2017; 31:100-105. [DOI: 10.1016/j.trre.2016.11.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 11/09/2016] [Indexed: 11/19/2022]
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17
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Gadelkareem R, Hameed D, Moeen A, El-Araby A, Mahmoud M, El-Taher A, El-Haggagy A, Ramzy M. Living donor kidney transplantation in the hemodialysis-naive and the hemodialysis-exposed: A short term prospective comparative study. AFRICAN JOURNAL OF UROLOGY 2017; 23:56-61. [DOI: 10.1016/j.afju.2016.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Massive Ascites in a Renal Transplant Patient after Laparoscopic Fenestration of a Lymphocele. Case Rep Transplant 2016; 2016:7491627. [PMID: 27891288 PMCID: PMC5116527 DOI: 10.1155/2016/7491627] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 10/19/2016] [Indexed: 11/17/2022] Open
Abstract
Retroperitoneal lymphocele is a common complication of renal transplantation. Here, we report the case of a 67-year-old woman with massive ascites after fenestration surgery for a lymphocele that developed following renal transplantation. She had been on continuous ambulatory peritoneal dialysis for 9 years. Living donor renal transplantation was performed and an intrapelvic lymphocele subsequently developed. The lymphocele did not resolve after aspiration therapy; therefore, laparoscopic fenestration was performed. Although the lymphocele disappeared, massive ascites appeared in its stead. Half a year later, the ascites was surgically punctured, which then gradually resolved and disappeared 6 weeks later. Aspiration therapy should be considered in patients on long-term peritoneal dialysis, although laparoscopic fenestration is safe and effective.
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Jun H, Hwang SH, Lim S, Kim MG, Jung CW. Evaluation of postoperative lymphocele according to amounts and symptoms by using 3-dimensional CT volumetry in kidney transplant recipients. Ann Surg Treat Res 2016; 91:133-8. [PMID: 27617254 PMCID: PMC5016603 DOI: 10.4174/astr.2016.91.3.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 05/23/2016] [Accepted: 05/30/2016] [Indexed: 12/05/2022] Open
Abstract
Purpose To analyze the risk factors for postoperative lymphocele, for predicting and preventing complications. Methods We evaluated 92 kidney transplant recipients with multidetector CT (MDCT) at 1-month posttransplantation. From admission and 1-month postoperative records, data including diabetes, dialysis type, immunosuppressant use, steroid pulse therapy, and transplantation side were collected. Lymphocele volume was measured with 3-dimensional reconstructed, nonenhanced MDCT at one month postoperatively. The correlations between risk factors and lymphocele volume and between risk factors and symptomatic lymphocele (SyL) were analyzed. The cutoff was calculated by using the receiver operating characteristic (ROC) curve for SyL volume. Results Among 92 recipients, the mean volume was 44.53 ± 176.43 cm3 and 12 had SyL. Univariable analysis between risk factors and lymphocele volume indicated that donor age, retransplantation, and inferiorly located lymphocele were statistically significant. The ROC curve for SyL showed that 33.20 cm3 was the cutoff, with 83.3% sensitivity and 93.7% specificity. On univariable analysis between risk factors and SyL, steroid pulse, inferiorly located lymphocele, and >33.20 cm3 were statistically significant. Multivariable analysis indicated that steroid pulse, >33.20 cm3, and serum creatinine level at one month were significant factors. Conclusion Risk factors including donor age, retransplantation, steroid pulse therapy, and inferiorly located lymphocele are important predictors of large lymphoceles or SyL. In high-risk recipients, careful monitoring of renal function and early image surveillance such as CT or ultrasound are recommended. If the asymptomatic lymphocele is >33.20 cm3 or located inferiorly, early interventions can be considered while carefully observing the changes in symptoms.
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Affiliation(s)
- Heungman Jun
- Department of Surgery, Korea University Anam Hospital, Seoul, Korea
| | - Sung Ho Hwang
- Department of Radiology, Korea University Anam Hospital, Seoul, Korea
| | - Sungyoon Lim
- Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Myung Gyu Kim
- Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Cheol Woong Jung
- Department of Surgery, Korea University Anam Hospital, Seoul, Korea.; Department of Surgery, Korea University College of Medicine, Seoul, Korea
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Fockens MM, Alberts VP, Bemelman FJ, van der Pant KAMI, Idu MM. Wound morbidity after kidney transplant. Prog Transplant 2015; 25:45-8. [PMID: 25758800 DOI: 10.7182/pit2015812] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
CONTEXT Wound morbidity is an important surgical complication after kidney transplant. OBJECTIVE To assess risk factors for postoperative wound complications and the impact of such complications on outcomes of kidney transplant. DESIGN AND PATIENTS Retrospectively, 108 consecutive kidney transplant patients between January 2010 and December 2010 were included in the analysis. Wound morbidity was defined as a surgical site infection or symptomatic lymphocele requiring intervention. Patient, donor, and surgical characteristics were reviewed. RESULTS Eight lymphoceles and 5 surgical site infections occurred in 12 patients. Risk factors for wound complications were recipient's age (P<.01), body mass index (P=.01), urinary tract infection (P=.01), and prolonged postoperative wound drainage (P=.047). Wound morbidity did not increase the incidence of delayed graft function, acute rejection, graft failure, or mortality. Obesity, recipient's age, urinary tract infection, and prolonged wound drainage are risk factors for wound-related complications. Graft and patient survival rates are comparable between patients with and without wound-related complications.
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Affiliation(s)
- M Matthijs Fockens
- Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands
| | - Victor P Alberts
- Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands
| | - Frederike J Bemelman
- Renal Transplant Unit, Department of Internal Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - Karlijn A M I van der Pant
- Renal Transplant Unit, Department of Internal Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - Mirza M Idu
- Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands
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Ranghino A, Segoloni GP, Lasaponara F, Biancone L. Lymphatic disorders after renal transplantation: new insights for an old complication. Clin Kidney J 2015; 8:615-22. [PMID: 26413290 PMCID: PMC4581383 DOI: 10.1093/ckj/sfv064] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 06/29/2015] [Indexed: 12/29/2022] Open
Abstract
In renal transplanted patients, lymphoceles and lymphorrhea are well-known lymphatic complications. Surgical damage of the lymphatics of the graft during the procurement and of the lymphatic around the iliac vessels of the recipients has been associated with development of lymphatic complications. However, lymphatic complications may be related to medical factors such as diabetes, obesity, blood coagulation abnormalities, anticoagulation prophylaxis, high dose of diuretics, delay in graft function and immunosuppressive drugs. Consistently, immunosuppression regimens based on the use of mTOR inhibitors, especially in association with steroids and immediately after transplantation, has been associated with a high risk to develop lymphocele or lymphorrhea. In addition, several studies have demonstrated the association between rejection episodes and lymphatic complications. However, before the discovery of reliable markers of lymphatic vessels, the pathogenic mechanisms underlining the development of lymphatic complications during rejection and the influence of mTOR inhibitors remained not fully understood. The recent findings on the lymphatic systems of either native or transplanted kidneys together with the advances achieved on lymphangiogenesis shared some lights on the pathogenesis of lymphatic complications after renal transplantation. In this review, we describe the surgical and medical causes of lymphatic complications focusing on the rejection and immunosuppressive drugs as causes of lymphatic complications.
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Affiliation(s)
- Andrea Ranghino
- Renal Transplantation Center 'A. Vercellone', Division of Nephrology Dialysis and Transplantation, Department of Medical Sciences , Città della Salute e della Scienza Hospital and University of Torino , Torino , Italy
| | - Giuseppe Paolo Segoloni
- Renal Transplantation Center 'A. Vercellone', Division of Nephrology Dialysis and Transplantation, Department of Medical Sciences , Città della Salute e della Scienza Hospital and University of Torino , Torino , Italy
| | - Fedele Lasaponara
- Division of Urology , Città della Salute e della Scienza Hospital , Torino , Italy
| | - Luigi Biancone
- Renal Transplantation Center 'A. Vercellone', Division of Nephrology Dialysis and Transplantation, Department of Medical Sciences , Città della Salute e della Scienza Hospital and University of Torino , Torino , Italy
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Urological Consequences following Renal Transplantation: A Review of the Literature. Urologia 2015; 82:211-8. [DOI: 10.5301/uro.5000132] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2015] [Indexed: 01/25/2023]
Abstract
Renal transplant (RT) represents the treatment of choice for end-stage renal disease (ESRD) but harbours a wide range of possible complications and therapeutic challenges of urological competence. Dialysis years and clinical medical background of these patients are risk factors for sexual dysfunction and lower urinary tract symptoms (LUTS). On the contrary, RT itself may have a number of possible surgical complications such as ureteral stenosis and urinary leakage, while immunosuppressive treatment is a known risk factor for de-novo malignancies. The present review describes the main urologic problems of RT patients and their up-to-date treatment options according to the most recently available literature evidences.
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The Use of Tenckhoff Catheters for Draining of Symptomatic Lymphoceles: A Review of Literature and Our Experience. Transplant Proc 2015; 47:384-7. [DOI: 10.1016/j.transproceed.2014.12.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 12/30/2014] [Indexed: 11/21/2022]
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Giuliani S, Gamba P, Kiblawi R, Midrio P, Ghirardo G, Zanon GF. Lymphocele after pediatric kidney transplantation: incidence and risk factors. Pediatr Transplant 2014; 18:720-5. [PMID: 25163815 DOI: 10.1111/petr.12341] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/23/2014] [Indexed: 11/30/2022]
Abstract
Lymphocele is a well-known postoperative complication after kidney transplantation. The aim of this study was to analyze time trend incidence, risk factors, and outcome of post-transplant lymphocele in a large pediatric cohort. This is a retrospective single institution review of 241 pediatric kidney transplants performed from 2000 to 2013. Etiology of end-stage renal disease, recipient age and gender, transplant year, BMI percentile for age, type of dialysis, living/non-living related donor, acute rejection, and multiple transplantations were analyzed in association with lymphocele formation. Fourteen of 241 (5.81%) children developed a postoperative lymphocele. There has been a reduction in the incidence of lymphocele after 2006 (3.22% vs. 8.55%, p < 0.05). Significant risk factors for lymphocele were older age (≥11 yr), transplant before 2006, male gender, BMI percentile for age ≥95%, and multiple transplantations (p < 0.05). The one-yr graft survival was significantly reduced in the group with lymphocele compared with control (81.2% vs. 92.51%, p < 0.04). This is the first pediatric report showing the following risk factors associated with post-transplant lymphocele: age ≥11 yr, male gender, BMI for age ≥95%, and multiple transplantations. A lymphocele can contribute to graft loss in the first-year post-transplant.
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Affiliation(s)
- Stefano Giuliani
- Department of Pediatric & Neonatal Surgery, St George's Healthcare NHS Trust and University, London, UK; Division of Pediatric Surgery, Department of 'Salute della Donna e del Bambino', University of Padova, Padova, Italy
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Kim MJ, Kim CS, Choi JS, Bae EH, Ma SK, Kim SW. Perirenal fluid collection after kidney transplantation. Chonnam Med J 2012; 48:57-9. [PMID: 22570817 PMCID: PMC3341439 DOI: 10.4068/cmj.2012.48.1.57] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Accepted: 03/20/2012] [Indexed: 11/17/2022] Open
Abstract
A 30-year-old male presented with pitting edema. He had received a kidney transplantation 3 months previously. His serum creatinine level was increased, and a renal ultrasound showed hypoechoic fluid collection in the perirenal space and pelvic cavity. We conducted sono-guided percutaneous drainage of the fluid collected in the pelvic cavity. The chemistry of the peritoneal fluid was more equivalent to serum chemistry values than to urinary values. Simple aspiration and treatment with antibiotics were performed. We have presented a case of lymphocele after kidney transplantation. This case suggests that physicians should remember how to differentiate the pelvic cavity fluid collection in patients who have received a kidney transplant.
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Affiliation(s)
- Min Jee Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
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