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Haq K, Yadav A, Mejia C. Approach to Kidney Allograft Dysfunction: A Brief Review. ADVANCES IN KIDNEY DISEASE AND HEALTH 2024; 31:416-426. [PMID: 39232612 DOI: 10.1053/j.akdh.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 06/06/2024] [Accepted: 06/12/2024] [Indexed: 09/06/2024]
Abstract
It is important for providers caring for kidney transplant recipients to be familiar with the common causes of allograft dysfunction. Early detection of allograft dysfunction leads to timely management, with the goal of preventing or delaying progression to allograft failure. Although transplant rejection is always a concern, the differential diagnoses for allograft dysfunction are broad and include perioperative complications, infections, recurrent disease, and calcineurin nephrotoxicity. In this review, we will go over early and late causes of allograft dysfunction and discuss the basic workup and principles of management for each condition.
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Affiliation(s)
- Kanza Haq
- Division of Nephrology, Johns Hopkins University, Baltimore, MD
| | - Anju Yadav
- Division of Nephrology and Hypertension, Thomas Jefferson University, Philadelphia, PA
| | - Christina Mejia
- Division of Nephrology, Johns Hopkins University, Baltimore, MD.
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Ay N, Alp V, Duymuş R, Çetin S. Lymphocele Outcomes After Renal Transplantations Performed by an Experienced Surgeon: Is Meticulously Performed Surgery and Experience Adequate to Prevent Lymphocele? Ann Transplant 2024; 29:e942656. [PMID: 38374615 PMCID: PMC10893763 DOI: 10.12659/aot.942656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 12/21/2023] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND The purpose of the present study was to analyze the rate of lymphoceles in kidney transplant operations meticulously performed by the same senior surgeon. MATERIAL AND METHODS The present study included 315 patients who were operated on in our organ transplantation center and followed up in the polyclinic after July 2013. The patients were retrospectively divided into 2 groups: patients with and without lymphocele. Symptomatic lymphocele (SL) has been defined as symptomatic fluid collection around the graft that necessitates an intervention for the graft or patient. RESULTS Lymphocele was observed in 82 (26%) patients. An intervention was needed in 16 (5.1%) of these cases. Demographic data such as age and sex of both groups were similar. Lymphocele cases were mostly asymptomatic, with a size <6 cm (75.6%). However, intervention was needed in 16 (75%) of the patients with a size ≥6 cm that were symptomatic. The length of time on dialysis in the pretansplant period was shorter in the group that developed lymphocele, and a lower rate of graft loss was observed in these patients. No statistically significant difference was found between the 2 groups in terms of rejection rates, serum albumin/globulin levels, and development of de novo DSA. CONCLUSIONS The risk factors reported in the literature related with lymphocele formation were not found to be statistically significant in our study. Complications, except lymphocele, were observed less frequently, but lymphocele formation was encountered in our patients despite meticulous surgery.
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Affiliation(s)
- Nurettin Ay
- Transplantation Center/General Surgery, Diyarbakir Training and Research Hospital, Diyarbakir, Turkey
| | - Vahhac Alp
- Transplantation Center/General Surgery, Diyarbakir Training and Research Hospital, Diyarbakir, Turkey
| | - Recai Duymuş
- Department of Radiology, Diyarbakir Training and Research Hospital, Diyarbakir, Turkey
| | - Sedat Çetin
- Department of Internal Medicine, Diyarbakir Training and Research Hospital, Diyarbakir, Turkey
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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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Yamada N, Kumagai M, Suzuki KS. A case of severe sciatica caused by a lymphocele after renal transplantation. JA Clin Rep 2022; 8:37. [PMID: 35644852 PMCID: PMC9148863 DOI: 10.1186/s40981-022-00527-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/19/2022] [Accepted: 05/20/2022] [Indexed: 11/10/2022] Open
Abstract
Background Sciatica is commonly caused by lumbar spinal disease. However, it can also be caused by tumors, infectious diseases, or muscle entrapment. We present a case of sciatica caused by a lymphocele after renal transplantation. Presentation A 50-year-old man who had undergone renal transplantation presented with sciatica and low back pain without leg edema. The patient was diagnosed with lumbar disc herniation during the first medical examination. Regardless of the treatment, the symptoms were exacerbated and red flag signs of low back pain were observed. Compression of the sciatic nerve by the lymphocele was confirmed by computed tomography. The sciatica was improved by ethanol injection for the lymphocele. Conclusions We encountered a rare case of severe sciatica without edema caused by lymphocele after renal transplantation. Careful examination is required to make a different diagnosis of lymphocele from other lumbar spinal diseases.
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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: 0] [Impact Index Per Article: 0] [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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Santiago Rubio J, Wojtowicz D, Amore MA, Iriarte G, Di Pietrantonio S. Giant Idiopathic Lymphocele 18 Years After Kidney Transplantation, Treated Using Lymphatic Embolization With Lipiodol: Report of a Rare Case. EXP CLIN TRANSPLANT 2021; 19:1099-1102. [PMID: 34641778 DOI: 10.6002/ect.2021.0226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Kidney transplant is the best therapeutic option for patients with end-stage kidney disease. However, kidney transplant is not exempt from postoperative complications. One of the most frequent urological complications is lymphocele, which can appearin up to 20% of patients. Lymphocele most often appears during the first month after surgery. However, its appearance after the first yearis completely infrequent. Here, we report a case of a giant idiopathic lymphocele 18 years after kidney transplant and its resolution with lymphatic embolization.The patient, a 34-year-old man who received a deceased-donor kidney transplant in 2002, had presented with no complications until the lymphocele was diagnosed. The lymphocele presented as a voluminous organ-compressing mass. A percutaneous drainage was placed, and 3600 cm3 of lymphatic fluidwere drained.Afterthat, 800 cm3 continued to leak every day. An intranodal lymphography and lymphatic embolization with Lipiodol Ultra-Fluide (Guerbet Australia) were performed, owing to the high amount of leakage. At 50 days after embolization, an ultrasonograph showed no fluid collections, so the percutaneous catheter was removed. In most patients, the treatment ofthe lymphocele after kidney transplant is frequently conservative. However,for patients whose situation cannot be resolved spontaneously, there are few therapeutic choices. As described here, intranodal lymphatic embolization is a mini-invasive option, with a success rate of up to 80%, and should be offered as the first approach.
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Affiliation(s)
- Juan Santiago Rubio
- >From the Servicio de Trasplante Renal, Hospital de Alta Complejidad en Red "El Cruce" Dr. Néstor Carlos Kirchner, Florencio Varela, Buenos Aires, Argentina
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Mok S, Park YJ, Park SC, Yun SS. Efficacy of Lymphatic Sealing Using the LigaSure in Kidney Transplantation: A Pilot Study. Transplant Proc 2021; 53:2278-2284. [PMID: 34404537 DOI: 10.1016/j.transproceed.2021.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 06/29/2021] [Accepted: 07/19/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Iliac vessel lymphatic ligation is critical in kidney transplantation, because it is associated with the occurrence of lymphocele. Lymphocele can also affect the renal graft. This study aimed to evaluate the efficacy of lymphatic sealing using LigaSure (an electrothermal bipolar sealing device) in kidney transplantation as compared with conventional silk-tie ligation. METHODS This retrospective study included 100 consecutive patients from a prospectively registered database who underwent kidney transplantation at Seoul St. Mary's Hospital, South Korea, between December 1, 2019 and November 12, 2020. Comorbidities, primary renal disease, transplantation variables, surgical variables, and posttransplantation outcomes were compared between conventional and LigaSure lymphatic ligations. Subgroup analyses were performed by anastomosis pattern. RESULTS The mean age of patients was 47.4 ± 12.40 (range, 24-73) years. The LigaSure and conventional groups comprised 50 (50%) patients. Hypertension history, number of anastomosed renal arteries, and anastomosis patterns differed significantly between groups (P < .05). No significant difference was found in postoperative outcomes. In the subgroup analysis, greater drain volume was found at postoperative day 1 in the end-to-end internal iliac artery-renal artery anastomosis group (P = .001) because the internal iliac artery dissection results in longer lymphatic ligation. Nevertheless, no differences in drain removal time (P = .528) or lymphocele incidence were found between subgroups. CONCLUSION LigaSure is expected to benefit from surgery time and will be identified in subsequent studies. LigaSure can be safely and comfortably used for iliac lymphatic ligation in kidney transplantation. In conclusion, LigaSure lymphatic ligation is superior to conventional lymphatic ligation in kidney transplantation.
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Affiliation(s)
- Sangkyun Mok
- Division of Vascular and Transplant Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Young Jun Park
- Division of Vascular and Transplant Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Sun Cheol Park
- Division of Vascular and Transplant Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
| | - Sang Seob Yun
- Division of Vascular and Transplant Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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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: 4] [Impact Index Per Article: 1.3] [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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Sharafeldeen M, Elgebaly O, Abou Youssif T, Fahmy A, Elsaqa M, Abdelsalam MS. Recipient and renal allograft survival following living related-donor transplantation: a single center experience. AFRICAN JOURNAL OF UROLOGY 2020. [DOI: 10.1186/s12301-020-00068-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Despite improvements in surgical techniques of renal transplantation, still surgical complications remain a big challenge that might affect the post-transplant recipient and graft outcome. The aim of the current study was to retrospectively assess the surgical complications following living related kidney transplants in our center from 1990 to 2012 and determine their impact on long term recipient and graft survival.
Methods
We conducted a retrospective study of all live related-donor kidney transplants performed at our tertiary referral center between June 1990 and December 2012. Data regarding recipient demographics, details of surgical techniques, any reported complications and cumulative recipient and graft survival was analyzed.
Results
One hundred and four patients were included in the study whom we had access to their complete hospital records and they didn’t miss follow up. There were 41 surgical complications reported in 37 recipients, prevalence of 35.5%. Vascular and urologic complications were reported in 17(16.3%) and 11 (10.5%) recipients respectively. Lymphocele was post-operatively diagnosed in nine (8.7%) recipients. Recipient survival at 1 year and 5-year were 100% and 97% respectively. Graft survival at 1 year and at 5 years were 96% and 85.5% respectively. Surgical complications mentioned, other than renal artery thrombosis, had no statistically significant impact on the graft and recipient survival.
Conclusion
Although surgical complications post-transplantation are not rare, the resulting morbidity can be minimized by prompt management of complications. In general, the existence of surgical complications did not impact recipient or graft survival.
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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: 5] [Impact Index Per Article: 1.3] [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.
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Wong BW. Lymphatic vessels in solid organ transplantation and immunobiology. Am J Transplant 2020; 20:1992-2000. [PMID: 32027464 DOI: 10.1111/ajt.15806] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 01/14/2020] [Accepted: 01/31/2020] [Indexed: 01/25/2023]
Abstract
With the recent advances in our understanding of the function and biology of the lymphatic vascular system, it is clear that the lymphatic system plays an integral role in physiology, and in pathological settings, may contribute to either enhance or repress inflammation and disease progression. Inflammation is central to both acute and chronic rejection in the context of solid organ transplantation, and emerging evidence suggests the lymphatic system plays a key role in shaping outcomes. The goals of this review are to highlight and contextualize the roles of lymphatic vessels and lymphangiogenesis in immunobiology, the impact immunosuppressive therapies have on the lymphatic system and emerging evidence of organ-specific heterogeneity of lymphatic vessels in the context of solid organ transplantation.
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Affiliation(s)
- Brian W Wong
- Laboratory of Lymphatic Metabolism + Epigenetics, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
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Peluso G, Incollingo P, Campanile S, Menkulazi M, Scotti A, Tammaro V, Calogero A, Dodaro C, Carlomagno N, Santangelo ML. Relation Between Wound Complication and Lymphocele After Kidney Transplantation: A Monocentric Study. Transplant Proc 2020; 52:1562-1565. [PMID: 32299707 DOI: 10.1016/j.transproceed.2020.02.053] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 02/05/2020] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Wound complication frequently arises after kidney transplantation and its risk factors are well known. In a previous paper we analyzed these factors, and in this new retrospective study we evaluate the influence of lymphocele in the development of wound complications. PATIENTS AND METHODS From January 2000 to December 2018, 731 consecutive kidney transplants have been performed in our center. We have analyzed the incidence of wound complication and lymphocele and their risk factors. RESULTS Out of 731 kidney transplants, we have observed wound complications in 115 patients (15.7%) and lymphocele in 158 patients (21.7%). Of these, 70 patients developed both complications (9.5%), but 6 patients have been excluded because they were in therapy with mammalian target of rapamycin inhibitors. Twenty-nine patients (45.3%) presented a first level and 35 patients (54.7%) showed second level wound complications. Lymphocele was the only present factor in just 3 cases (4.6%). The other patients showed diabetes in 28 cases (43.7%), overweight/obesity in 38 (59.3%), delayed graft function in 17 (26.5%), and 60 years or more in 38 (57.8%). The association has been found in 30 out 64 patients treated with tacrolimus (46.8%) and in 34 with cyclosporine (53.1%); 40 patients did not receive muscular layer's reconstruction (62.5%). CONCLUSION Our experience shows that lymphocele alone is not a predisposing factor for wound dehiscence after kidney transplantation, and they often coexist because they share the same risk factors, the most important being obesity, diabetes and delayed graft function, older age, and surgical techniques. No relation has been observed with calcineurin inhibitor therapy.
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Affiliation(s)
- Gaia Peluso
- Operative Unit of General Surgery and Kidney Transplantation - Advanced Biomedical Science Department - University Federico II of Naples, Naples, Italy
| | - Paola Incollingo
- Operative Unit of General Surgery and Kidney Transplantation - Advanced Biomedical Science Department - University Federico II of Naples, Naples, Italy
| | - Silvia Campanile
- Operative Unit of General Surgery and Kidney Transplantation - Advanced Biomedical Science Department - University Federico II of Naples, Naples, Italy.
| | - Marsela Menkulazi
- Operative Unit of General Surgery and Kidney Transplantation - Advanced Biomedical Science Department - University Federico II of Naples, Naples, Italy
| | - Alessandro Scotti
- Operative Unit of General Surgery and Kidney Transplantation - Advanced Biomedical Science Department - University Federico II of Naples, Naples, Italy
| | - Vincenzo Tammaro
- Operative Unit of General Surgery and Kidney Transplantation - Advanced Biomedical Science Department - University Federico II of Naples, Naples, Italy
| | - Armando Calogero
- Operative Unit of General Surgery and Kidney Transplantation - Advanced Biomedical Science Department - University Federico II of Naples, Naples, Italy
| | - Concetta Dodaro
- Operative Unit of General Surgery and Kidney Transplantation - Advanced Biomedical Science Department - University Federico II of Naples, Naples, Italy
| | - Nicola Carlomagno
- Operative Unit of General Surgery and Kidney Transplantation - Advanced Biomedical Science Department - University Federico II of Naples, Naples, Italy
| | - Michele L Santangelo
- Operative Unit of General Surgery and Kidney Transplantation - Advanced Biomedical Science Department - University Federico II of Naples, Naples, Italy
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