1
|
Guachetá-Bomba PL, Sandoval Guerrero MF, Ramirez G, Garcia-Perdomo HA. Lymphocele Complication After Kidney Transplant: Current Literature Review and Management Algorithm. EXP CLIN TRANSPLANT 2023; 21:855-859. [PMID: 38140928 DOI: 10.6002/ect.2023.0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
Kidney transplant is the best treatment option for patients with end-stage renal disease. It reduces mortality and improves the quality of life. However, kidney transplant presents medical and surgical complications, and one of the most common is the posttransplant lymphocele. Lymphocele complication has an incidence of up to 20% and presents with variable clinical symptoms, which are directly associated with the size and compression effect on the adjacent organs. There are reported risk factors that favor the appearance of lymphocele. Despite known factors, there are more relevant factors (male sex, deceased donor, and corticosteroids) to carry out a stricter follow-up. The treatment of lymphoceles can vary according to the severity of the symptoms, characteristics of the collection, and the patient's clinical status. Despite the high recurrence, percutaneous intervention is the initial approach in this condition. If percutaneous aspiration, drainage, and sclerotherapy are unsuccessful, then open or laparoscopic fenestration can be performed; laparoscopy is the standard of treatment since it is highly effective and has few adverse effects.
Collapse
|
2
|
Seyferth ER, Itkin M, Nadolski GJ. Intranodal Glue Embolization for Postoperative Lymphatic Leaks in the Groin and Pelvis: Comparison with Sclerotherapy. J Vasc Interv Radiol 2022; 34:600-606. [PMID: 36563935 DOI: 10.1016/j.jvir.2022.12.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 12/10/2022] [Accepted: 12/13/2022] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To compare the effectiveness of and adverse events related to intranodal glue embolization (IGE) with those of intracavitary sclerotherapy for the treatment of postoperative groin and pelvic lymphatic leaks. MATERIALS AND METHODS From November 2015 to July 2021, IGE for postoperative pelvic or groin lymphocele or lymphorrhea was performed in 33 patients. From January 2010 to July 2021, 28 patients with postoperative pelvic or groin lymphocele were treated with sclerosis alone. Clinical success was defined as resolution of drainage within 3 weeks of the last intervention performed without recurrence. Patients presenting >1 year after surgery or with <30 days of follow-up were excluded. Patients with lymphorrhea treated with IGE were not statistically compared with those in the sclerosis group because they were not eligible for sclerosis. RESULTS Clinical success was similar between the groups (lymphocele IGE, 15/18, 83.3%, vs sclerosis, 15/23, 65.2% [P = .29]; lymphorrhea IGE, 8/9, 88.9%). The mean number of interventions performed to successfully treat a lymphocele was significantly higher in the sclerosis group (2.5 for sclerosis vs 1.3 for IGE; P = .003; lymphorrhea IGE, 1.0). The mean time to resolution was significantly longer for sclerosis than for IGE (27 vs 7 days; P = .002; 4 days for lymphorrhea IGE). There were no sclerosis-related adverse events and 2 IGE-related adverse events: (a) 1 case of mild lymphedema and (b) 1 case of nontarget embolization resulting in deep vein thrombosis. CONCLUSIONS For treatment of postoperative pelvic and groin lymphoceles, IGE results in faster resolution with fewer interventions compared with sclerosis. IGE is also an effective treatment for postoperative groin lymphorrhea.
Collapse
Affiliation(s)
- Elisabeth R Seyferth
- Department of Interventional Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Maxim Itkin
- Department of Interventional Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gregory J Nadolski
- Department of Interventional Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| |
Collapse
|
3
|
Kashiwagi E, Ono Y, Yano H, Kosai S, Nagai K, Tanaka K, Higashihara H, Tomiyama N. Percutaneous sclerotherapy with OK-432 for lymphocele after pelvic or para-aortic lymphadenectomy: preliminary results. CVIR Endovasc 2022; 5:55. [PMID: 36264442 PMCID: PMC9584008 DOI: 10.1186/s42155-022-00332-z] [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: 08/02/2022] [Accepted: 10/14/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Lymphoceles can result from disruption of lymphatic vessels after surgical procedures in areas with extensive lymphatic networks. Percutaneous catheter drainage with sclerotherapy can be performed for the treatment of lymphoceles. OK-432 has been used to treat benign cysts, such as lymphangioma and ranula. Therefore, we aimed to report the efficacy and safety of sclerotherapy using OK-432 for postoperative lymphoceles. This study retrospectively analyzed 16 patients who underwent sclerotherapy using OK-432 for postoperative pelvic and para-aortic lymphoceles between April 1, 2012, and March 31, 2020. All the patients underwent percutaneous drainage before sclerotherapy. The indications for sclerotherapy were persistent drainage tube output of greater than 50 mL per day and recurrent lymphoceles after percutaneous drainage. If less than 20 mL per day was drained after sclerotherapy, the tube was removed. When the drainage tube output did not decrease to less than 20 mL per day after the first sclerotherapy, the second sclerotherapy was performed 1 week later. Technical success was defined as the completion of drainage and sclerotherapy procedures. Clinical success was defined as the resolution of the patient's symptoms resulting from lymphoceles without surgical intervention. This study also evaluated the complications of sclerotherapy and their progress after sclerotherapy. RESULTS The mean initial lymphocele size and drainage duration after sclerotherapy were 616 mL and 7.1 days, respectively. The technical success rate and clinical success rate were 100% and 93%, respectively. Thirteen patients were treated by one-session sclerotherapy and three patients were treated by two-session sclerotherapy. Minor complications (fever) were observed in eight patients (50%). A major complication (small bowel fistula) was observed in one patient (7%). No recurrence of lymphoceles was observed during the mean follow-up period of 17 months. CONCLUSION Sclerotherapy with OK-432 is an effective therapeutic method for postoperative lymphoceles. Although most complications are minor, a small bowel fistula was observed in one patient.
Collapse
Affiliation(s)
- Eiji Kashiwagi
- grid.136593.b0000 0004 0373 3971Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Yusuke Ono
- grid.136593.b0000 0004 0373 3971Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Hiroki Yano
- grid.136593.b0000 0004 0373 3971Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Shinya Kosai
- grid.136593.b0000 0004 0373 3971Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Keisuke Nagai
- grid.136593.b0000 0004 0373 3971Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Kaishu Tanaka
- grid.136593.b0000 0004 0373 3971Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Hiroki Higashihara
- grid.136593.b0000 0004 0373 3971Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Noriyuki Tomiyama
- grid.136593.b0000 0004 0373 3971Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| |
Collapse
|
4
|
Povidone-iodine sclerotherapy of primary symptomatic lymphocele after kidney transplantation. Int Urol Nephrol 2020; 53:685-690. [PMID: 33170487 DOI: 10.1007/s11255-020-02709-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 11/03/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To report the efficacy and safety of povidone-iodine sclerotherapy of primary symptomatic lymphocele after kidney transplantation in a large contemporary cohort study. PATIENTS AND METHODS A single-institutional study was conducted including consecutive patients who underwent povidone-iodine sclerotherapy for primary symptomatic lymphocele after kidney transplantation between January 2013 and March 2020. Sclerotherapy was used as the first-line treatment of symptomatic lymphocele. Recurrent lymphoceles were managed with open or laparoscopic fenestration. The primary outcome was the efficacy of sclerotherapy which was defined as the absence of second sclerotherapy or salvage surgery. RESULTS A total of 965 renal transplantations were included. Sclerotherapy for primary symptomatic lymphocele was performed in 60 cases (6.2%). The median (IQR) number of instillation, the volume of povidone-iodine per instillation and drainage time were 3 (3-3), 60 (38-80) mL and 6 days (5-8), respectively. Sclerotherapy related complications were reported in eight cases (13.3%) and included five cases of accidental catheter removal, two cases of lumbosciatica, and one case of intraperitoneal diffusion of povidone-iodine. After a median (IQR) follow-up of 33 (14-60) months, treatment success was achieved in 33 cases (55%). Multivariate analysis failed to identify predictors of sclerotherapy failure. Salvage therapies included 7 s sclerotherapy and 20 surgical fenestrations with an overall success rate of 88.8% (24/27). CONCLUSIONS Sclerotherapy was an easy and safe procedure to treat primary symptomatic lymphocele in renal transplant recipients. Despite moderate efficacy, recurrences were easily controlled with salvage therapies. Further studies are necessary to identify predictive factors of sclerotherapy failure to directly refer patients to surgical treatment.
Collapse
|
5
|
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: 11] [Impact Index Per Article: 2.8] [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.
Collapse
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
| |
Collapse
|
6
|
Pal D, Roy P, Chatterjee A, Jana D, Mandal D. The role of povidone-iodine in prevention of lymphorrhea after kidney transplant surgery - A prospective, pilot study. INDIAN JOURNAL OF TRANSPLANTATION 2020. [DOI: 10.4103/ijot.ijot_96_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
7
|
Wu X, Luo Y, Zeng Y, Peng W, Zhong Z. Prospective comparison of indwelling cannulas drain and needle aspiration for symptomatic seroma after mastectomy in breast cancer patients. Arch Gynecol Obstet 2019; 301:283-287. [PMID: 31781890 PMCID: PMC7028817 DOI: 10.1007/s00404-019-05396-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 11/20/2019] [Indexed: 12/01/2022]
Abstract
Aims Postoperative seroma is the most frequent sequelae after mastectomy and axillary surgery with no optimal regimens for seroma resolution recommended in routine clinical. Indwelling cannulas with needle and catheter have been widely used in long-term medication therapies, but evidence of indwelling cannulas in seroma management after mastectomy is lacking. The purpose of this study is to evaluate the feasibility of indwelling cannulas in seroma management after mastectomy. Methods Patients who underwent modified radical mastectomy (MRM) and developed symptomatic seroma after removal of the drains between August 2017 and December 2018, were randomized into two groups either indwelling cannulas drain of seroma (Group A) or needle aspiration of seroma (Group B). We prospectively compared the number of visits for seroma, the time from removal of the drain to the final seroma resolution and the cost between the methods. Results A total of 860 patients underwent MRM between August 2017 and December 2018, among which 86 patients who developed symptomatic seroma after removal of the drains, were randomized into two groups either Group A or Group B. The number of visits for seroma in Group A was 2.35 ± 0.69 times, which was less than those in Group B (4.86 ± 1.06 times). Similarly, the time of drain removal to final seroma resolution in Group A was 4.65 ± 0.78 days, which was shorter than 7.09 ± 1.54 in Group B. In Group A, the total mean cost per patient (25.81 ± 7.71 RMB) was less than the total mean cost per patient (49.30 ± 9.85 RMB) in Group B. Cost savings were noted with using indwelling cannulas in seroma management. Conclusion It is feasible to drain indwelling cannulas drain for postmastectomy seroma, with less visits for patients, rapid seroma resolution and less cost. Indwelling cannulas can be an efficient, cost effective solution to treat symptomatic seroma after breast surgery.
Collapse
Affiliation(s)
- Xiufeng Wu
- Department of Breast Surgical Oncology, Fujian Medical University Cancer Hospital & Fujian Cancer Hospital, No. 420 Fu Ma Road, Fuzhou, 350014, Fujian, People's Republic of China.
| | - Yiping Luo
- Department of Anesthesiology, Fujian Medical University Cancer Hospital & Fujian Cancer Hospital, Fuzhou, 350014, Fujian, People's Republic of China
| | - Yi Zeng
- Department of Breast Surgical Oncology, Fujian Medical University Cancer Hospital & Fujian Cancer Hospital, No. 420 Fu Ma Road, Fuzhou, 350014, Fujian, People's Republic of China
| | - Wei Peng
- Department of Clinical Laboratory, Fujian Medical University Cancer Hospital & Fujian Cancer Hospital, Fuzhou, 350014, Fujian, People's Republic of China
| | - Zhaoming Zhong
- Department of Ultrasound, Fujian Medical University Cancer Hospital & Fujian Cancer Hospital, Fuzhou, 350014, Fujian, People's Republic of China
| |
Collapse
|
8
|
Sureka SK, Yadav P, Singh UP, Lal H, Kapoor R, Ansari MS, Srivastava A. Role of early povidone iodine instillation in post-renal transplant lymphorrhea: A prospective randomized study. Turk J Urol 2019; 45:461-466. [PMID: 31603421 DOI: 10.5152/tud.2019.88137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 03/01/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of the present study was to prospectively evaluate the role of early povidone iodine instillation in the management of post-renal transplant lymphorrhea. MATERIAL AND METHODS Live-related renal transplant recipients operated between January 2002 and December 2015 were included in the study. Significant lymphorrhea was defined as >50 mL lymph from drain beyond postoperative day 5. Such patients were randomized into two groups by simple randomization using a computer-generated random list: group A (received 0.5% povidone iodine instillation) and group B (no instillation). Absolute risk reduction and numbers needed to treat were calculated to estimate the effect of povidone iodine instillation for the treatment of lymphorrhea and decrease in the incidence of lymphocoele. RESULTS A total of 1766 patients underwent renal transplant during this period. One hundred seventeen patients with lymphorrhea through the drain underwent randomization into group A (n=61) and group B (n=56). In group A, 58 patients had successful resolution within 2 weeks, whereas in group B, 34 patients had successful resolution within 2 weeks. Overall, 9 (14.75%) patients in group A and 29 (51.78%) patients in group B had lymphatic collections (both symptomatic and asymptomatic). Symptomatic lymphocoele was present in 1 patient in group A and 7 patients in group B on follow-up. Absolute risk reduction was 10.8%, and for every symptomatic lymphocoele prevented, 10 patients needed povidone iodine instillation. CONCLUSION Povidone iodine instillation after 5 days of transplantation aids in the early resolution of post-renal transplantation lymphorrhea, as well as reduces the incidence of future lymphocoele.
Collapse
Affiliation(s)
- Sanjoy K Sureka
- Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Priyank Yadav
- Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Uday Pratap Singh
- Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Hira Lal
- Department of Radiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Rakesh Kapoor
- Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Mohd S Ansari
- Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Aneesh Srivastava
- Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| |
Collapse
|
9
|
Evaluation of sclerotherapy for the treatment of infected postoperative lymphocele. Taiwan J Obstet Gynecol 2017; 56:477-481. [DOI: 10.1016/j.tjog.2016.10.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2016] [Indexed: 11/20/2022] Open
|
10
|
Treatment of Post-transplant Lymphocele in Children. Urology 2017; 103:218-223. [PMID: 28132852 DOI: 10.1016/j.urology.2016.12.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 12/07/2016] [Accepted: 12/21/2016] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To review our single-center experience in managing posttransplant lymphoceles in pediatric kidney recipients. Lymphoceles are well-known complications after pediatric kidney transplantation (KT). However, there is no standard treatment for lymphoceles, and the literature lacks consensus on which is the most appropriate approach. MATERIALS AND METHODS We reviewed our retrospective institutional database for recipients of pediatric KT performed between January 2000 and December 2015 who developed lymphoceles. RESULTS Out of the 176 patients who underwent KT, lymphoceles occurred in 9 (5.1%) patients. The mean age of recipients in this group was 12.8 years (standard deviation [SD] 4.8) (r: 1-17) and the mean body weight was 43.1 kg (SD 18.8) (r: 9.5-69). Mean lymphocele onset was 32.2 days (SD 23.4) (r: 11-85) post transplantation. Six patients presented with increased serum creatinine from the baseline, whereas 3 patients remained asymptomatic. Ultrasound was the primary diagnostic procedure in all patients. Lymphoceles resolved spontaneously in asymptomatic patients (n = 3), and thus these patients were not further treated. All symptomatic patients (n = 6) were treated: 2 underwent percutaneous catheter drainage and 4 underwent transcatheter sclerotherapy (TS). The main sclerosing agent used was povidone-iodine. In 3 patients, TS with povidone-iodine failed, and they underwent additional procedures: 2 underwent TS with polidocanol and 1 underwent open drainage. There was no graft loss in any of the patients, and no recurrence was documented during a follow-up period of mean 30.3 months (SD 15.6) (r: 7-57). CONCLUSION There is no gold-standard treatment for lymphoceles in children, and reports in the literature on the topic are scarce. Percutaneous catheter drainage with or without TS is safe and effective, although it can lengthen hospitalization and increase morbidity.
Collapse
|
11
|
Presser N, Kerr H, Gao T, Begala M, Paschal S, Shoskes DA, Flechner SM. Fibrin Glue Injections: A Minimally Invasive and Cost-Effective Treatment for Post-Renal Transplant Lymphoceles and Lymph Fistulas. Am J Transplant 2016; 16:694-9. [PMID: 26461049 DOI: 10.1111/ajt.13470] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 07/21/2015] [Accepted: 07/21/2015] [Indexed: 01/25/2023]
Abstract
Pelvic lymphoceles/lymph fistulas are commonly observed after kidney allotransplantation, especially when the kidney is placed in a retroperitoneal position. While the majority are <5 cm in diameter and resolve without intervention, some may continue to enlarge, and cause local or systemic symptoms or graft dysfunction. Among 1662 recipients of both living and deceased donor kidney transplants between January 2003 and July 2014, we found 46 (2.7%) patients with symptomatic lymphoceles requiring intervention. We studied the clinical outcomes and charges for three treatment modalities including open surgical drainage (22), laparoscopic surgical drainage (11), and percutaneous fibrin glue injections into the drained lymphocele cavity (13). The patient demographics and clinical characteristics were comparable for each treatment group, although maintenance immunosuppressive drugs differed by era. We found fibrin glue injections resulted in significantly lower (p = 0.04) rates of recurrence (1; 7.7%) than either laparoscopic (6; 54%) or open surgical drainage (6; 27.3%). In addition, fibrin glue injections generated significantly (p < 0.001) lower median ($4559) charges compared to either laparoscopic ($26,330) or open surgical drainage ($23,758). Fibrin glue treatment has the advantage of being an outpatient procedure, performed with the patient under local anesthesia, and does not incur the expense of an operative procedure or hospital admission associated with laparoscopic or open surgery.
Collapse
Affiliation(s)
- N Presser
- Renal Transplant Program, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - H Kerr
- Renal Transplant Program, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - T Gao
- Renal Transplant Program, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - M Begala
- Renal Transplant Program, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - S Paschal
- Renal Transplant Program, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - D A Shoskes
- Renal Transplant Program, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - S M Flechner
- Renal Transplant Program, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH
| |
Collapse
|
12
|
Bleomycin sclerotherapy for severe symptomatic and persistent pelvic lymphocele. Case Rep Obstet Gynecol 2014; 2014:624803. [PMID: 25105040 PMCID: PMC4109129 DOI: 10.1155/2014/624803] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 05/28/2014] [Accepted: 06/11/2014] [Indexed: 11/17/2022] Open
Abstract
Background. Pelvic lymphoceles are frequently described as a complication of pelvic lymphadenectomy performed for surgical staging of gynaecologic malignancies. Case Report. A 72-year-old woman presented with severe symptomatic and refractory lymphocele associated with persistent lower limb lymphedema and recurrent erysipelas. After four CT fluoroscopy scan guided percutaneous catheter drainages, the lymphocele complicated with infection finally resolved with two sessions of bleomycin sclerotherapy. Conclusion. Symptomatic persistent lymphoceles require treatment and nowadays the first option is interventional radiologic procedures. Bleomycin is a safe and effective sclerosing agent and therefore should be regarded as a first-line treatment choice.
Collapse
|
13
|
Weinberger V, Cibula D, Zikan M. Lymphocele: prevalence and management in gynecological malignancies. Expert Rev Anticancer Ther 2014; 14:307-17. [DOI: 10.1586/14737140.2014.866043] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
14
|
Incidence of lymphoceles in patients undergoing renal transplantation and the effect of povidone–iodine in treatment. INDIAN JOURNAL OF TRANSPLANTATION 2013. [DOI: 10.1016/j.ijt.2013.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
15
|
An institutional based study of post-operative surgical complications of live related renal transplant recipients. INDIAN JOURNAL OF TRANSPLANTATION 2013. [DOI: 10.1016/j.ijt.2013.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
16
|
Rana Y, Singh D, Gupta S, Pradhan A, Talwar R, Harkar S, Swami Y. Urological and vascular complications in 720 renal transplantations – Lessons learned. INDIAN JOURNAL OF TRANSPLANTATION 2012. [DOI: 10.1016/j.ijt.2012.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
|
17
|
Management of postoperative lymphoceles after lymphadenectomy: percutaneous catheter drainage with and without povidone-iodine sclerotherapy. Cardiovasc Intervent Radiol 2012; 36:466-71. [PMID: 22484702 DOI: 10.1007/s00270-012-0375-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Accepted: 03/15/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE To report our single-center experience in managing symptomatic lymphoceles after lymphadenectomy for genitourinary and gynecologic malignancy and to compare clinical outcomes of percutaneous catheter drainage (PCD) alone versus PCD with transcatheter povidone-iodine sclerotherapy (TPIS). METHODS The medical records of patients who presented for percutaneous drainage of pelvic lymphoceles from February 1999 to September 2007 were retrospectively reviewed. Catheters with prolonged outputs >50 cc/day were treated with TPIS. Technical success was defined as the ability to achieve complete resolution of the lymphocele. Clinical success was defined as resolution of the patient's symptoms that prompted the intervention. RESULTS Sixty-four patients with 70 pelvic lymphoceles were treated. Forty-six patients (71.9 %) had PCD, and 18 patients (28.1 %) had multisession TPIS. The mean initial cavity size was 294.9 cc for those treated with TPIS and 228.2 cc for those treated with PCD alone (range 15-1,600) (p = 0.59). Mean duration of catheter drainage was 19 days (29 days with TPIS, 16 days with PCD, p = 0.001). Mean clinical follow-up was 22.6 months. Technical success was 74.3 % with PCD and 100 % with TPIS. Clinical success was 97 % with PCD and 100 % with TPIS. Postprocedural complications included pericatheter fluid leakage (n = 4), catheter dislodgement (n = 3), catheter occlusion (n = 9), and secondary infection of the collection (n = 4). CONCLUSION PCD of symptomatic lymphoceles is an effective postoperative management technique. Initial cavity size is not an accurate predictor of the need for TPIS. When indicated, TPIS is safe and effective with catheter outputs >50 cc/day.
Collapse
|
18
|
Management of primary symptomatic lymphocele after kidney transplantation: a systematic review. Transplantation 2011; 92:663-73. [PMID: 21849931 DOI: 10.1097/tp.0b013e31822a40ef] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Management of lymphoceles after kidney transplantation is highly variable. The aim of this study was to evaluate and compare the different approaches of lymphocele management among kidney transplant recipients. METHODS MEDLINE and EMBASE were systematically searched for case studies published between 1954 and 2010. Inclusion criteria were symptomatic lymphoceles developing in recipients of deceased or living donor kidneys with specified intervention and outcome. Primary outcome was the rate of recurrence. Secondary outcomes were the rate of conversion from laparoscopic to open surgery, hospital stay, and complication rates. RESULTS Fifty-two retrospective case series with 1113 cases of primary lymphocele were selected for review. No randomized controlled trials or prospective cohort studies were located. Primary treatment modalities included were as follows: aspiration (n=218), sclerotherapy (n=155), drainage (n=219), laparoscopic surgery (n=333), and open surgery (n=188). Of the 218 cases of lymphocele managed with aspiration alone, 141 recurred with a recurrence rate of 59% (95% confidence interval [CI]: 52-67). Among those who received laparoscopic and open surgery, the recurrence rates were 8% (95% CI: 6-12) and 16% (95% CI: 10-24), respectively. The conversion rate from laparoscopic to open surgery was 12% (95% CI: 8-16). CONCLUSIONS Laparoscopic fenestration of a symptomatic lymphocele is associated with the lowest risk of lymphocele recurrence. However, the evidence base to support a recommendation for laparoscopic surgery as first line treatment is weak and highlights the need for a multicenter prospective cohort study to examine the benefits of incorporating initial simple aspiration into the management of lymphocele after kidney transplantation.
Collapse
|
19
|
Abstract
Various collections can develop in the space surrounding a renal transplant. These collections can present at any point in time from the immediate post transplant period to several months post transplantation and can be incidental or cause significant transplant dysfunction. The use on computed tomography and ultrasound allows for the imaging characteristics of these collections and their relationship to the transplanted kidney to be easily characterized. Standard means of percutaneously accessing the collections to obtain fluid is instrumental in diagnosing their etiology. Urinomas, hematomas, seroma, lymphomas and abscesses can be seen. The management of these collections is dependent on the nature of the peritransplant collection. Optimal care of patients with peritransplant collections is best attained by considered collaboration of a multi-specialty team.
Collapse
Affiliation(s)
- Howard M Richard
- Interventional Radiology, Washington Hospital Center, Washington, District of Columbia
| |
Collapse
|
20
|
Vo NJ, Hanevold CD, Edwards R, Hoffer FA, Koyle MA. Recurrent Page kidney in a child with a congenital solitary kidney requiring capsular artery embolization. Pediatr Radiol 2010; 40:1837-40. [PMID: 20333510 DOI: 10.1007/s00247-010-1630-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2009] [Revised: 02/06/2010] [Accepted: 02/26/2010] [Indexed: 11/30/2022]
Abstract
We report an unusual case of a child with a congenital solitary functional kidney complicated by a sports-related posttraumatic Page kidney. The child developed severe hypertension and renal insufficiency requiring percutaneous intervention to preserve renal function. The literature is sparse with no definitive guidelines for the treatment of Page kidney. Following the initial unsuccessful treatment with percutaneous drainage and sclerotherapy procedures, the child ultimately required catheter-directed particle embolization of the capsular arteries to resolve a recurrent subscapsular hematoma definitively. This was successful in preserving renal function and stabilization of the clinical manifestations of the Page kidney.
Collapse
Affiliation(s)
- Nghia-Jack Vo
- Department of Radiology, Section of Pediatric Interventional Radiology, Pediatric Radiology, and Vascular Interventional Radiology (M/S R-5417), Seattle Children's Hospital and University of Washington, 4800 Sand Point Way NE, Seattle, WA 98105, USA.
| | | | | | | | | |
Collapse
|
21
|
Sun GH, Fu YT, Wu CJ, Chang SY. POVIDONE-IODINE INSTILLATION FOR MANAGEMENT OF PELVIC LYMPHOCELE AFTER PELVIC LYMPHADENECTOMY FOR STAGING PROSTATE CANCER. ACTA ACUST UNITED AC 2009; 49:463-6. [PMID: 14555330 DOI: 10.1080/01485010390219935] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The development of postoperative lymphoceles following pelvic lymph node dissection is a rare complication. It is a well-described complication of kidney transplantation. A patient who developed a symptomatic pelvic lymphocele after pelvic lymph node dissection for staging prostatic cancer was treated with percutaneous tube drainage, but the treatment was in vain. Successful treatment was accomplished with povidone-iodine instillation into the lymphocele. This simple, safe, and painless method for lymphocele treatment is recommended.
Collapse
Affiliation(s)
- G-H Sun
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, National Defense University, No. 325, Section 2 Cheng-Gung Road, Neihu 114, Taipei, Taiwan, ROC.
| | | | | | | |
Collapse
|
22
|
Throckmorton AD, Askegard-Giesmann J, Hoskin TL, Bjarnason H, Donohue JH, Boughey JC, Degnim AC. Sclerotherapy for the treatment of postmastectomy seroma. Am J Surg 2008; 196:541-4. [DOI: 10.1016/j.amjsurg.2008.06.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2008] [Revised: 06/04/2008] [Accepted: 06/04/2008] [Indexed: 12/01/2022]
|
23
|
Akhan O, Karcaaltincaba M, Ozmen MN, Akinci D, Karcaaltincaba D, Ayhan A. Percutaneous transcatheter ethanol sclerotherapy and catheter drainage of postoperative pelvic lymphoceles. Cardiovasc Intervent Radiol 2007; 30:237-40. [PMID: 17205362 DOI: 10.1007/s00270-006-0180-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The aim of this study is to investigate the efficacy and long-term results of percutaneous transcatheter ethanol sclerotherapy (PTES) for postoperative pelvic lymphocele treatment. Fifty-two patients who were referred for lymphocele treatment were included in this study. Sixty lymphoceles of 52 patients were treated by percutaneous treatment with or without ethanol sclerotherapy. Lymphoceles developed in 47 and 5 patients, who underwent gynecologic malignancy operation (31 ovarian cancer, 6 cervix cancer, 10 endometrial cancer) and renal transplantation, respectively. Lymphoceles were catheterized by ultrasonography and fluoroscopy guidance using the Seldinger technique. Lymphoceles smaller than 150 mL underwent single-session ethanol sclerotherapy and the others were treated by multiple-session ethanol sclerotherapy. In 10 patients, percutaneous ethanol sclerotherapy could not be performed and they were treated only by percutaneous catheter drainage. The mean lymphocele volume was 329 mL (15-2900 mL). The mean catheterization duration was 11.8 days (1-60 days). The mean follow up time was 25.8 months (2-64 months). The initial treatment was successful in 46 out of 50 (91%) lymphoceles treated with PTES and 7 out of 10 (70%) lymphoceles treated with percutaneous catheter drainage. Minor complications (secondary infection and catheter dislodgement) were noted in seven (11.6%) patients. Recurrence developed in four and three patients who were treated by PTES and percutaneous catheter drainage, respectively. Five of these patients were treated with PTES without further recurrence. Percutaneous transcatheter ethanol sclerotherapy is an effective and reliable method for the treatment of postoperative lymphoceles.
Collapse
Affiliation(s)
- Okan Akhan
- Department of Radiology, Hacettepe University School of Medicine, 06100 Ankara, Turkey
| | | | | | | | | | | |
Collapse
|
24
|
Smyth GP, Beitz G, Eng MP, Gibbons N, Hickey DP, Little DM. Long-Term Outcome of Cadaveric Renal Transplant After Treatment of Symptomatic Lymphocele. J Urol 2006; 176:1069-72. [PMID: 16890692 DOI: 10.1016/j.juro.2006.04.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2005] [Indexed: 11/18/2022]
Abstract
PURPOSE Between January 1993 and December 2002 a total of 1,289 renal transplants were performed at our institution. Symptomatic post-transplant lymphocele presenting as increased creatinine and hydronephrosis of the allograft was recorded at 0.02%. Records of the 27 patients in whom symptomatic lymphocele developed and of those who underwent contralateral kidney transplant (control group) were compared to determine the long-term effects of lymphocele formation on allograft function. MATERIALS AND METHODS A total of 37 procedures for the treatment of lymphocele were performed in 24 patients. Open marsupialization (12) and laparoscopic marsupialization (3) procedures were performed as primary treatments. Two patients underwent repeat open marsupialization. Aspiration and percutaneous catheter drainage were performed as a primary procedure in 7 and 1 cases, respectively. Percutaneous nephrostomy was required in 4 cases before definitive treatment. RESULTS The mean time to development of a lymphocele was 121 days (range 35 to 631). Symptomatic lymphocele did not require treatment in 3 patients. Of 19 patients undergoing primary marsupialization, recurrence in 2 necessitated repeat surgery. However, aspiration and percutaneous drainage proved to be definitive in only 2 cases. In total 8 patients required more than 1 procedure. At a mean followup of 63 months (SD 30.3) 21 allografts continued to function with a mean serum creatinine of 152 mumol/l (SD 67.9). In the control group 3 patients experienced graft failure and mean serum creatinine was 154 mumol/l (SD 51.9). Five patients died in the lymphocele group, 2 with functioning grafts compared to 4 deaths in the control group. CONCLUSIONS Surgical marsupialization is the preferred primary treatment for symptomatic lymphocele and is associated with excellent long-term allograft outcome.
Collapse
Affiliation(s)
- G P Smyth
- Department of Urology and Transplantation, Beaumont Hospital, Dublin 9, Ireland
| | | | | | | | | | | |
Collapse
|
25
|
Karcaaltincaba M, Akhan O. Radiologic imaging and percutaneous treatment of pelvic lymphocele. Eur J Radiol 2005; 55:340-54. [PMID: 15885959 DOI: 10.1016/j.ejrad.2005.03.007] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2005] [Revised: 03/07/2005] [Accepted: 03/10/2005] [Indexed: 11/19/2022]
Abstract
Pelvic lymphocele, also known as lymphocyst, is a cystic structure caused by lymphatic injury usually secondary to pelvic lymphadenectomy and renal transplantation. Lymphoceles can cause morbidity and rarely mortality by compression of adjacent structures and infectious complications. This review discusses etiology and treatment options for pelvic lymphoceles including surgical and percutaneous methods with emphasis on percutaneous techniques particularly in conjunction with sclerotherapy. Percutaneous catheter drainage with sclerotherapy procedure with various sclerosing agents is described in detail. Ethanol, povidone-iodine, tetracycline, doxycycline, bleomycin, talc and fibrin glue can be used as sclerosing agents. Combination of sclerosing agents to percutaneous catheter drainage significantly improves success rate in the treatment of pelvic lymphoceles. Infected lymphoceles are usually treated solely with percutaneous catheter drainage. Percutaneous treatment can be tailored according to volume of lymphoceles. We generally prefer single session sclerotherapy and 1 day catheter drainage in lymphoceles less than 150 mL, and larger ones are treated by multi-session sclerotherapy until daily drainage decreases below 10 mL. Percutaneous treatment preferably with sclerotherapy should be considered as the first-line treatment modality for pelvic lymphoceles due to its effectiveness, widespread applicability on an outpatient basis, ease of procedure and low complication rate.
Collapse
Affiliation(s)
- Musturay Karcaaltincaba
- Department of Radiology, Division of Abdominal and Interventional Radiology, Hacettepe University School of Medicine, Sihhiye, Ankara 06100, Turkey
| | | |
Collapse
|
26
|
Burgos FJ, Pascual J, Marcen R, García-Navas R, Gómez V, Ortuño J. The role of imaging techniques in renal transplantation. World J Urol 2004; 22:399-404. [PMID: 15517281 DOI: 10.1007/s00345-004-0412-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2004] [Accepted: 04/28/2004] [Indexed: 11/30/2022] Open
Abstract
Our aim is to review the utility of the different imaging techniques in the field of renal transplantation (RT). A total of 500 potential RT recipients have been evaluated and were included in the waiting list. From 1978 to 2003, a total of 900 RT recipients were clinically followed-up and different imaging techniques assessed. The main indications for the different techniques were: (1) MR angiography to establish the vascular anatomy of the living donor with 95% accuracy for the detection of multiple renal vessels. (2) Abdominal ultrasound of the donor in order to detect lithiasis, incidental renal tumors or anatomic anomalies. (3) Vascular evaluation of the recipients was essential considering the aging character of this population. X-ray film of the abdomen was a routine technique. Doppler ultrasound (DOP-US) of the iliac vessels and an angiographic study (DSA, CT, MR) of the iliac and splenic arteries were indicated only in selected cases. (4) DOP-US was useful in the diagnosis of graft dysfunction after RT. It allowed the exclusion of thrombosis and urinary obstruction, and was useful to distinguish between acute tubular necrosis, cyclosporine nephrotoxicity and acute rejection (AR). (5) Finally, ultrasound was used as a percutaneous approach to pyelocaliceal systems of grafts affected by ureteral stenosis or fistula and for draining fluid collections after RT (lymphocele, abscess, hematoma or urinoma).
Collapse
Affiliation(s)
- F Javier Burgos
- Department of Urology, Hospital Ramon y Cajal, Universidad de Alcalá, Madrid, Spain.
| | | | | | | | | | | |
Collapse
|
27
|
Dammeier BG, Lehnhardt A, Glüer S, Offner G, Nashan B, Ure BM. Laparoscopic fenestration of posttransplant lymphoceles in children. J Pediatr Surg 2004; 39:1230-2. [PMID: 15300533 DOI: 10.1016/j.jpedsurg.2004.04.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND/PURPOSE Lymphoceles are frequently observed as a surgical complication after renal transplantation. Whereas the frequency, pathogenesis, diagnosis, and treatment of lymphoceles has been well described in adult patients, no data are available for the pediatric age group. METHODS Since December 2000; 5 children (2 boys and 3 girls; median age, 6 years; range, 6 to 15 years) of a total of 21 (10 boys and 11 girls; median age, 13 years; range, 2 to 19 years) children undergoing kidney transplantation had a posttransplant lymphocele. The clinical course, renal function, and ultrasonographic appearance of the transplanted kidney of all children were observed in a prospective manner. RESULTS The lymphoceles became obvious between day 13 and 48 (median, 20 days) posttransplantation. Lymphocele size ranged from 2.0 x 3.0 cm to 11.0 x 15.0 cm. They were localized at any site (superior, inferior, lateral, medial, and dorsal) around the transplanted kidney. Four patients had a significant decrease of renal function, in 2 children mild urinary tract obstruction occurred, and 1 patient suffered from considerable abdominal pain. Diagnosis was established by ultrasound scan in all cases. All patients were treated by laparoscopic fenestration of the lymphocele immediately after diagnosis, except 1 patient, in whom fenestration was not done until 10 months later. Operating time ranged from 45 to 90 minutes (median, 62 minutes). No intraoperative or postoperative complication occurred. Renal function, urinary tract obstruction, and pain recovered soon after operation in all patients. After 3 to 10 months (median, 8 months) postoperatively, no relapse has been observed. CONCLUSIONS Our data emphasize laparoscopic fenestration as the treatment of choice for children with posttransplant lymphoceles, because it is safe, effective, and technically easy to perform. If done early after diagnosis, renal function will recover immediately.
Collapse
|
28
|
Ahmadnia H, Yarmohamadi A. Percutaneous drainage of perirenal abscess after kidney transplantation: a 4-year experience. Transplant Proc 2003; 35:2670-1. [PMID: 14612065 DOI: 10.1016/j.transproceed.2003.08.074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- H Ahmadnia
- Ghaem Medical Center, Ghaem Medical Centre, Mashhad University of Medical Sciences, Mashhad, Iran.
| | | |
Collapse
|
29
|
Chin AI, Ragavendra N, Hilborne L, Gritsch HA. Fibrin sealant sclerotherapy for treatment of lymphoceles following renal transplantation. J Urol 2003; 170:380-3. [PMID: 12853780 DOI: 10.1097/01.ju.0000074940.12565.80] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Fibrin sealant is used in various surgical fields for hemostasis and as an adhesive to approximate tissues. Its use was recently reported as a sclerosing agent for percutaneous treatment of lymphoceles following renal transplantation. We report on the use of fibrin glue sclerotherapy at this institution for the management of renal transplant related lymphoceles. MATERIALS AND METHODS We reviewed the records of 8 patients at a single institution with lymphoceles after renal transplantation treated with percutaneous fibrin glue sclerosis. RESULTS Treatment success was achieved in 6 patients (75%), with resolution of lymphoceles assessed with clinical and imaging findings. Four patients (50%) required 2 applications of fibrin sealant, with 2 (25%) subsequently requiring surgical management of the lymphoceles. Clinical followup averaged 27.7 months (range 4 to 44). Complications included lymphocele recurrence, clogging of drainage catheters and catheter dislodgement. CONCLUSIONS The experience of 8 patients suggests that fibrin glue sclerotherapy may be considered a safe and effective method of treating symptomatic lymphoceles when simple percutaneous drainage has failed. The percutaneous approach does not require hospital admission and is less invasive than surgical treatment.
Collapse
Affiliation(s)
- Arnold i Chin
- Medical Scientist Training Program, David Geffen School of Medicine, University of California, Los Angeles, 90095, USA
| | | | | | | |
Collapse
|
30
|
Surlan M, Popovic P. The role of interventional radiology in management of patients with end-stage renal disease. Eur J Radiol 2003; 46:96-114. [PMID: 12714226 DOI: 10.1016/s0720-048x(03)00074-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The aim of the paper is to review the role of interventional radiology in the management of hemodialysis vascular access and complications in renal transplantation. The evaluation of patients with hemodialysis vascular access is complex. It includes the radiology/ultrasound (US) evaluation of the peripheral veins of the upper extremities with venous mapping and the evaluation of the central vein prior to the access placement and radiological detection and treatment of the stenosis and thrombosis in misfunctional dialysis fistulas. Preoperative screening enables the identification of a suitable vessel to create a hemodynamically-sound dialysis fistula. Clinical and radiological detection of the hemodynamically significant stenosis or occlusion demands fistulography and endovascular treatment. Endovascular prophylactic dilatation of stenosis greater than 50% with associated clinical abnormalities such as flow-rate reduction is warranted to prolong access patency. The technical success rates are over 90% for dilatation. One-year primary patency rate in forearm fistula is 51%, versus graft 40%. Stents are placed only in selected cases; routinely in central vein after dilatation, in ruptured vein and elastic recoil. Thrombosed fistula and grafts can be declotted by purely mechanical methods or in combination with a lytic drug. The success rate of the technique is 89-90%. Primary patency rate is 8-26% per year and secondary 75% per year. The most frequently radiologically evaluated and treated complications in renal transplantation are perirenal and renal fluid collection and abnormalities of the vasculature and collecting system. US is often the method of choice for the diagnostic evaluation and management of the percutaneous therapeutic procedures in early and late transplantation complications. Computed tomography and magnetic resonance are valuable alternatives when US is inconclusive. Renal and perirenal fluid collection are usually treated successfully with percutaneous drainage. Doppler US, magnetic resonance angiography and digital subtraction angiography have a principle role in the evaluation of vascular complications of renal transplantation and management of the endovascular therapy. Stenosis, the most common vascular complication, occurs in 1-12% of transplanted renal arteries and represents a potentially curable cause of hypertension following transplantation and/or renal dysfunction. Treatment with percutaneous transluminal renal angioplasty (PTRA) or PTRA with stent has been technically successful in 82-92% of the cases, and graft salvage rate has ranged from 80 to 100%. Restenosis occurs in up to 20% of cases, but are usually amenable to repeated PTRA. Complications such as arterial and vein thrombosis are uncommon. Intrarenal A/V fistulas and pseudoaneurysms are occasionally seen after biopsy, the treatment requires superselective embolisation. Urologic complications are relatively uncommon, predominantly they consist of the urinary leaks and urethral obstruction. Interventional treatment consists of percutaneous nephrostomy, balloon dilation, insertion of the double J stents, metallic stent placement and external drainage of the extrarenal collections.
Collapse
Affiliation(s)
- M Surlan
- Department of Clinical Radiology, University Hospital, Zaloska 2, Ljubljana, Slovenia
| | | |
Collapse
|
31
|
Knoll GA, Nichol G. Dialysis, kidney transplantation, or pancreas transplantation for patients with diabetes mellitus and renal failure: a decision analysis of treatment options. J Am Soc Nephrol 2003; 14:500-15. [PMID: 12538753 DOI: 10.1097/01.asn.0000046061.62136.d4] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Patients with type 1 diabetes mellitus and end-stage renal disease may remain on dialysis or undergo cadaveric kidney transplantation, living kidney transplantation, sequential pancreas after living kidney transplantation, or simultaneous pancreas-kidney transplantation. It is unclear which of these options is most effective. The objective of this study was to determine the optimal treatment strategy for type 1 diabetic patients with renal failure using a decision analytic Markov model. Input data were obtained from the published medical literature, the United Network for Organ Sharing registry, and patient interviews. The outcome measures were life expectancy (in life-years [LY]) and quality-adjusted life expectancy (in quality-adjusted life-years [QALY]). Living kidney transplantation was associated with 18.30 LY and 10.29 QALY; pancreas after kidney transplantation, 17.21 LY and 10.00 QALY; simultaneous pancreas-kidney transplantation, 15.74 LY and 9.09 QALY; cadaveric kidney transplantation, 11.44 LY and 6.53 QALY; dialysis, 7.82 LY and 4.52 QALY. The results were sensitive to the value of several key variables. Simultaneous pancreas-kidney transplantation had the greatest life expectancy and quality-adjusted life expectancy when living kidney transplantation was excluded from the analysis. These data indicate that living kidney transplantation is associated with the greatest life expectancy and quality-adjusted life expectancy for type 1 diabetic patients with renal failure. Treatment strategies involving pancreas transplantation should be considered for patients with frequent metabolic complications of diabetes and for those patients who favor kidney-pancreas transplantation over kidney transplantation alone. For patients without a living donor, simultaneous pancreas-kidney transplantation is associated with the greatest life expectancy.
Collapse
Affiliation(s)
- Greg A Knoll
- Division of Nephrology, Department of Medicine, University of Ottawa, Canada.
| | | |
Collapse
|
32
|
Langer RM, Kahan BD. Incidence, therapy, and consequences of lymphocele after sirolimus-cyclosporine-prednisone immunosuppression in renal transplant recipients. Transplantation 2002; 74:804-8. [PMID: 12364859 DOI: 10.1097/00007890-200209270-00012] [Citation(s) in RCA: 132] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In a retrospective study we sought to dissect the factors associated with an increased occurrence of clinically significant perinephric fluid collections and lymphoceles among sirolimus-treated renal transplant recipients. METHODS We compared the incidence, predisposing factors, and consequences of these fluid collections among patients treated with sirolimus-cyclosporine (CsA)-prednisone (Pred) (n=354, group I) versus CsA-Pred with or without azathioprine (n=136, group II). RESULTS More group I patients (135/354; 38.1%) displayed perinephric fluid collections (denoted as group III) then group II patients (24/136; 17.6%) (denoted as group IV) (P <0.001). In both subgroups the serum creatinine levels were elevated at the time of diagnosis from a nadir of 2.04+/-1.61 to 4.09+/-2.95 mg/dL (group III) and from 2.53+/-2.34 to 4.36+/-2.90 mg/dL (group IV). A significantly greater number of patients required treatment for lymphoceles among group I (56/354; 15.8%) versus group II recipients (6/136; 4.4%; P<0.001). Single or repeated percutaneous drainage procedures successfully treated 35 group I patients versus all 6 group IV patients (P =0.033). No patients in group II versus 21 patients in group I underwent surgical procedures (P <0.001). A significantly higher rate and higher histologic grade of acute rejection episodes, particularly proximate to the onset of the lymphocele, occurred among group IV patients, namely 54.2% (13/24) versus 21.4% (29/135) group III patients (P <0.001). CONCLUSIONS Addition of sirolimus to a CsA-Pred regimen resulted in both a higher incidence and a requirement for more aggressive treatment of perinephric fluid collections and lymphoceles.
Collapse
Affiliation(s)
- Robert M Langer
- The University of Texas Medical School at Houston, Department of Surgery, Division of Immunology and Organ Transplantation, Houston, TX 77030, USA
| | | |
Collapse
|
33
|
Manfro RC, Comerlato L, Berdichevski RH, Ribeiro AR, Denicol NT, Berger M, Saitovitch D, Koff WJ, Gonçalves LF. Nephrotoxic acute renal failure in a renal transplant patient with recurrent lymphocele treated with povidone-iodine irrigation. Am J Kidney Dis 2002; 40:655-7. [PMID: 12200820 DOI: 10.1053/ajkd.2002.34930] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Povidone-iodine sclerosis has been suggested in the literature as a safe and effective treatment for post-renal transplant lymphoceles. No significant complications of this method have been described. We report on a kidney allograft recipient with recurrent lymphoceles treated with povidone-iodine instillations who developed acute renal failure secondary to iodine intoxication. Four days after the beginning of the povidone-iodine irrigations, metabolic acidosis was present, and renal function started to deteriorate. After a few days, despite the suspension of irrigations, the patient developed oliguria, and dialysis was needed. A renal biopsy was performed, and intense acute tubular necrosis was the only relevant finding. The lymphocele was corrected surgically, and the patient eventually recovered. As has been described in other settings, povidone-iodine instillation for the treatment of post-renal transplant lymphoceles may lead to iodine kidney toxicity and acute renal failure.
Collapse
Affiliation(s)
- Roberto C Manfro
- Renal Transplant Unit, Division of Nephrology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul School of Medicine, Porto Alegre, RS, Brazil.
| | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Doehn C, Fornara P, Fricke L, Jocham D. Laparoscopic fenestration of posttransplant lymphoceles. Surg Endosc 2002; 16:690-5. [PMID: 11972216 DOI: 10.1007/s00464-001-9150-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2001] [Accepted: 09/26/2001] [Indexed: 10/28/2022]
Abstract
BACKGROUND A lymphocele is a common finding after renal transplantation and occurs in up to 20% of patients. The majority of patients are asymptomatic. However, once a lymphocele has become symptomatic (e.g., through transplant dysfunction) this condition has to be treated. We report our 9-year experience with laparoscopic lymphocele fenestration and discuss the current management options for posttransplant lymphoceles. METHODS Since 1993, 19 patients (11 males and 8 females; median age 56 years, range 22-68 years) of a total of 31 patients with a symptomatic posttransplant lymphocele have undergone laparoscopic fenestration of their lymphocele at a median of 66 days (range, 19-111 days) following successful renal transplantation in our department. As a first-line treatment, a percutaneous pigtail drainage catheter was inserted in all patients. In case of failure in resolving the fluid collection, the next step included sclerotherapy by instillation of tetracycline or ethanol into the lymphocele cavity in some cases. In patients with a persistent lymphocele, a laparoscopic lymphocele fenestration via a transabdominal approach was undertaken to achieve adequate drainage. RESULTS Primary laparoscopic lymphocele fenestration was successful in all except two patients, who required a conversion. The median operating time was 36 min (range, 20-70 min). Following the procedure, renal transplant function remained stable or returned to individually normal levels in all patients. Median duration of hospital stay was 4 days (range, 1-13 days). At median follow-up of 27 months, all patients were alive with a functioning transplant. CONCLUSIONS Laparoscopic lymphocele fenestration is reserved for patients in whom temporary drainage with or without sclerotherapy failed to resolve the fluid collection. In these cases the laparoscopic approach offers obvious technical and clinical advantages compared to open operative techniques.
Collapse
Affiliation(s)
- C Doehn
- Department of Urology, University of Luebeck Medical School, Ratzeburger Allee 160, 23538 Luebeck, Germany.
| | | | | | | |
Collapse
|
35
|
Muñoz P. Management of urinary tract infections and lymphocele in renal transplant recipients. Clin Infect Dis 2001; 33 Suppl 1:S53-7. [PMID: 11389523 DOI: 10.1086/320905] [Citation(s) in RCA: 85] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The most frequent infectious complication after renal transplantation is urinary tract infection. This article deals with antimicrobial prophylaxis, treatment of early and relapsing urinary tract infections, and management of asymptomatic bacteriuria in renal transplant patients. The incidence of lymphocele after renal transplantation varies, and its treatment is still controversial. Management options are discussed.
Collapse
Affiliation(s)
- P Muñoz
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| |
Collapse
|
36
|
Zurera LJ, Bravo F, Canis M, Ribes R, Regueiro JC, Pérez-Calderón R. Escleroterapia percutánea de linfoceles con. RADIOLOGIA 2001. [DOI: 10.1016/s0033-8338(01)76991-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
37
|
Bischof G, Rockenschaub S, Berlakovich G, Längle F, Mühlbacher F, Függer R, Steininger R. Management of lymphoceles after kidney transplantation. Transpl Int 1998. [DOI: 10.1111/j.1432-2277.1998.tb00970.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
38
|
Seelig MH, Klingler PJ, Oldenburg WA. Treatment of a postoperative cervical chylous lymphocele by percutaneous sclerosing with povidone-iodine. J Vasc Surg 1998; 27:1148-51. [PMID: 9652477 DOI: 10.1016/s0741-5214(98)70017-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The development of postoperative leaks of the thoracic duct after neck dissection or vascular surgery of the subclavian and vertebral artery is a well-known but rare complication. Usually, an injury of the duct manifests immediately after the operation with chylous drainage. Presentation as a postoperative lymphocele is rare. Operative treatment may be an option, but identification of the leak often is impossible, resulting in a high rate of failure. Percutaneous catheter drainage in combination with sclerosis with povidone-iodine has proved to be highly effective in obliterating pelvic lymphoceles but has not been reported in patients who have undergone vascular surgery in the neck. We present a case in which a povidone-iodine solution was used successfully in percutaneous sclerosis of a cervical lymphocele after transposition of the left subclavian artery to the left common carotid artery.
Collapse
Affiliation(s)
- M H Seelig
- Department of Surgery, Mayo Clinic Jacksonville, FL 32224, USA
| | | | | |
Collapse
|