1
|
Sabagh M, Sabetkish N, Fakour S, Ramouz A, Weber S, Mieth M, Lurje G, Golriz M, Zeier M, Mehrabi A, Khajeh E. Methods to prevent lymphocele after kidney transplantation: Seeking the optimal technique for avoiding a preventable complication. Transplant Rev (Orlando) 2024; 38:100877. [PMID: 39142043 DOI: 10.1016/j.trre.2024.100877] [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: 07/20/2024] [Revised: 08/05/2024] [Accepted: 08/06/2024] [Indexed: 08/16/2024]
Abstract
BACKGROUND There are multiple methods for preventing lymphocele formation after kidney transplantation (KTx). However, lymphoceles still develop in up to one third of patients and the effectiveness of these different methods in preventing lymphocele is not well described. Here, we summarize the current strategies for preventing lymphocele after KTx. METHODS We conducted searches across several literature databases, including Medline (via PubMed), Web of Science, EMBASE, and Cochrane Central. Lymphocele formation after KTx was the outcome of interest. A random-effects model was applied to evaluate pooled estimates, which were presented as hazard ratios (HRs) and odds ratios (ORs), along with the random pooled estimate (ES), 95% confidence interval (95% CI), and P value. We calculated the pooled rate of lymphocele formation after KTx with the following preventive methods: LigaSure, haemostatic materials, prophylactic drainage, ligation, peritoneal fenestration, and bipolar cautery techniques. RESULTS The literature search retrieved 87 unique studies after excluding duplicates. Twenty papers reporting on 5445 patients were incorporated in the qualitative analysis. The pooled lymphocele rate was 3.0% (95% CI = 0.6-13.7) for the LigaSure method, 8.3% (95% CI = 6.4-10.7) for drainage, 9.2% (95% CI = 5.9-14.1) for haemostatic materials, 12.2% (95% CI = 9.2-16.1) for ligation, 14.4% (95% CI = 12.0-17.3) for peritoneal fenestration, and 20.5% (95% CI = 10.2-36.8) for bipolar sealing. CONCLUSION Despite preventive methods, the incidence of lymphocele following KTx remains high. The use of LigaSure appears to be the most effective method for preventing lymphocele. However, given the broad range of reported lymphocele rates and lack of control groups, further validation of these findings is necessary.
Collapse
Affiliation(s)
- Mohammadsadegh Sabagh
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Nastaran Sabetkish
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Sanam Fakour
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Ali Ramouz
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Sanaz Weber
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Markus Mieth
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Georg Lurje
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Mohammad Golriz
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany; Department of General and Visceral Surgery, Diakonie Clinic Jung-Stilling, Siegen, Germany
| | - Martin Zeier
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Arianeb Mehrabi
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Elias Khajeh
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
| |
Collapse
|
2
|
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
|
3
|
Agarwal N, Kumar GR, Singh Rana AK, Mubeen A, Dokania MK. Predictors of Lymphatic Complications Following Renal Transplant: A Prospective Study Involving Predominantly Living Donor Transplants From India. Cureus 2021; 13:e17133. [PMID: 34532172 PMCID: PMC8437002 DOI: 10.7759/cureus.17133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction Lymphatic complications (LC) are common (up to 33%) and troublesome after renal transplantation. Different studies have established varying medical and surgical risk factors, mostly by retrospective analysis on deceased donor renal transplants (DDRTs). The end-point is mostly lymphocele, with few reports documenting the equally important lymphorrhea. Methods In our prospective analytical study done over three years, most were living donor renal transplant (LDRT) pairs by a single team. The primary outcome measure was lymphocele and/or prolonged drainage for more than 15 days, with a six-month follow-up. The variables recorded were age, gender, hemodialysis duration, etiology, relationship, human leucocyte antigen (HLA) mismatch, induction regimen, acute rejection, warm ischemia time (WIT), and delayed graft function (DGF). Univariate analysis was by chi-square and t-tests as applicable, while logistic regression (both simultaneous and forward stepwise) was used for risk factor prediction. Results Eligible cases were 150, with 145 (97%) LDRT pairs. Donors were mostly female (122/150; 81%) with mean age (~43 years) higher than recipient age (~33 years). The common etiologies were diabetes (31%), hypertension (23%), and IgA nephropathy (11%). Most donors were mothers (37%) and wives (31%), and 28% of LDRT pairs had HLA mismatch >3. Mean duration of hemodialysis was about 18 months, and mean WIT was 52 minutes. Both DGF (B coefficient= -1.69, p<0.000) and WIT (B=-0.038, p=0.024) were significant predictors of the primary outcome, while drain removal before 15 days predicted lymphocele significantly (B=-2.4, p<0.000). Conclusions LDRT has specific risk factors for lymphatic complications, which may be related to extent of recipient vascular dissection, arterial anastomotic time, and early drain removal.
Collapse
Affiliation(s)
- Nitin Agarwal
- Transplant Unit, Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences and Ram Manohar Lohia Hospital, Delhi, IND
| | - Gyan R Kumar
- Transplant Unit, Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences and Ram Manohar Lohia Hospital, Delhi, IND
| | - Anil K Singh Rana
- Transplant Unit, Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences and Ram Manohar Lohia Hospital, Delhi, IND
| | - Abdul Mubeen
- Transplant Unit, Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences and Ram Manohar Lohia Hospital, Delhi, IND
| | - Manoj K Dokania
- Transplant Unit, Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences and Ram Manohar Lohia Hospital, Delhi, IND
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
O'Kelly F, Lorenzo AJ, Zubi F, De Cotiis K, Farhat WA, Koyle MA. The impact of multiple donor renal arteries on perioperative complications and allograft survival in paediatric renal transplantation. J Pediatr Urol 2021; 17:541.e1-541.e11. [PMID: 33883096 DOI: 10.1016/j.jpurol.2021.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 01/21/2021] [Accepted: 03/18/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The impact of using allografts with multiple renal arteries in paediatric kidney transplantation has not been clearly established. The aim of this study was to determine whether kidney grafts with multiple arteries pose any adverse effects upon perioperative surgical outcomes, and graft survival up to 12 months post-transplant. OBJECTIVE The objective of this study was to perform a comparative analysis of a minimum of 12-month graft survival and transplant renal function in paediatric renal transplant recipients receiving single versus multiple donor arteries, and to assess perioperative and early post-operative surgical outcomes. STUDY DESIGN A retrospective divisional chart review of 379 transplants performed (2000-2018), of which 90 (23.7%) contained multiple donor arteries. The number of arteries of the graft, donor type, vascular reconstruction technique, occurrence of urological and vascular complications, estimated GFR and graft survival up to 12 months post-transplantation, graft loss and mortality were analysed. Comparisons in baseline characteristics and outcome measures were made between both groups. RESULTS No significant differences were found in age (p = 0.42), BMI (p = 0.39), estimated intraoperative blood loss (p = 0.14), overall (p = 0.63) or warm ischaemic time (p = 0.37). 51.3% patients with multiple donor arteries underwent an ex vivo reconstruction. There were no differences in the site of arterial anastomosis (aorta, external iliac, internal iliac), or anastomotic type (end-side; end-end). Whilst there was a significantly higher post-operative lymphocoele rate in the multiple vessel cohort (p = 0.024), there was no increase in post-transplant urine leaks, rejection episodes, graft loss (1.1% multiple vs 2.1% single), perioperative complications (p = 0.68), or estimated GFR at 1 month (p = 0.9) or at 1 year (p = 0.67). DISCUSSION We demonstrated in this study that there was no significant difference in postoperative complications up to 3 months, eGFR and renal function up to 1 year, and graft survival up to 4 years post transplantation irrespective of allograft type or reconstruction technique. There was however, a higher rate of lymphocoeles in the multiple artery cohort. The results seen here broadly mirror trends seen in adult studies, however, there is little data available from paediatric series. CONCLUSION Our study demonstrates that multiple renal artery allografts - previously been considered to carry a high complication risk - can be safely used for paediatric renal transplantation with equivalent perioperative complications and graft outcomes to single artery allografts.
Collapse
Affiliation(s)
- F O'Kelly
- Division of Pediatric Urology, Hospital for Sick Children, Toronto, Canada; Division of Paediatric Urology, Beacon Hospital, University College, Dublin, Ireland.
| | - A J Lorenzo
- Division of Pediatric Urology, Hospital for Sick Children, Toronto, Canada
| | - F Zubi
- Division of Pediatric Urology, Hospital for Sick Children, Toronto, Canada
| | - K De Cotiis
- Division of Pediatric Urology, Hospital for Sick Children, Toronto, Canada; Division of Pediatric Urology, Neymours/duPont Childrens Hospital, Delaware, USA
| | - W A Farhat
- Division of Pediatric Urology, Hospital for Sick Children, Toronto, Canada; Division of Pediatric Urology, American Family Childrens Hospital, Wisconsin, USA
| | - M A Koyle
- Division of Pediatric Urology, Hospital for Sick Children, Toronto, Canada
| |
Collapse
|
6
|
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.
Collapse
|
7
|
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
|
8
|
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
|
9
|
Heer MK, Clark D, Trevillian PR, Sprott P, Palazzi K, Hibberd AD. Functional significance and risk factors for lymphocele formation after renal transplantation. ANZ J Surg 2017; 88:597-602. [DOI: 10.1111/ans.14343] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 11/08/2017] [Accepted: 11/13/2017] [Indexed: 01/23/2023]
Affiliation(s)
- Munish K. Heer
- Newcastle Transplant Unit; John Hunter Hospital; Newcastle New South Wales Australia
- The University of Newcastle; Newcastle New South Wales Australia
- Hunter Transplant Research Foundation; Newcastle New South Wales Australia
| | - David Clark
- Newcastle Transplant Unit; John Hunter Hospital; Newcastle New South Wales Australia
- The University of Newcastle; Newcastle New South Wales Australia
| | - Paul R. Trevillian
- Newcastle Transplant Unit; John Hunter Hospital; Newcastle New South Wales Australia
- The University of Newcastle; Newcastle New South Wales Australia
- Hunter Transplant Research Foundation; Newcastle New South Wales Australia
- Hunter Medical Research Institute; Newcastle New South Wales Australia
| | - Philip Sprott
- Newcastle Transplant Unit; John Hunter Hospital; Newcastle New South Wales Australia
- The University of Newcastle; Newcastle New South Wales Australia
| | - Kerrin Palazzi
- Hunter Medical Research Institute; Newcastle New South Wales Australia
| | - Adrian D. Hibberd
- Newcastle Transplant Unit; John Hunter Hospital; Newcastle New South Wales Australia
- The University of Newcastle; Newcastle New South Wales Australia
- Hunter Transplant Research Foundation; Newcastle New South Wales Australia
- Hunter Medical Research Institute; Newcastle New South Wales Australia
| |
Collapse
|
10
|
Lucan CV, Jurchis I, Suciu M, Selicean SE, Buttice S. Modern lymphatic dissection techniques for preventing post renal transplant lymphocele. Med Pharm Rep 2017; 90:416-419. [PMID: 29151791 PMCID: PMC5683832 DOI: 10.15386/cjmed-716] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 10/12/2016] [Indexed: 12/23/2022] Open
Abstract
Background and aims Development of a lymphocele is a well-known complication following kidney transplant. Among causative factors, recipient iliac lymphatics dissection plays an important role. Electrothermal bipolar sealing devices (LigaSureTM) have been shown to decrease lymphatic leakage in a number of instances. The aim of this study was to investigate whether the use of this device decreases post-operative lymphatic complications in kidney transplant. Methods 48 patients admitted for renal transplant were included in the study. They were randomly assigned to either conventional ligation or LigaSureTM during lymphatic dissection. Results One patient in the LigaSureTM arm and 5 patients in the conventional ligation arm developed lymphocele (p=0.04). Lymphatic drainage volumes were 99.8±39.87 ml in the LigaSure arm and 131.46±54.2 ml in the conventional ligation arm (p=0.02). Conclusion Electrothermal bipolar sealing devices exhibit safety and efficiency when used in renal transplant lymphatic dissection. In the present study, this technique proved to be superior to conventional ligation in terms of post-operative lymphatic complications.
Collapse
Affiliation(s)
- Ciprian Valerian Lucan
- Institute of Urology and Renal Transplantation, Cluj-Napoca, Romania.,Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ionut Jurchis
- Department of Urology, St. Ioan County Hospital, Suceava, Romania
| | - Mihai Suciu
- Institute of Urology and Renal Transplantation, Cluj-Napoca, Romania.,Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | - Salvatore Buttice
- Department of Urology, Messina University Hospital; Hospital Clinic Barcelona, Italy
| |
Collapse
|
11
|
Ranghino A, Segoloni GP, Lasaponara F, Biancone L. Lymphatic disorders after renal transplantation: new insights for an old complication. Clin Kidney J 2015; 8:615-22. [PMID: 26413290 PMCID: PMC4581383 DOI: 10.1093/ckj/sfv064] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 06/29/2015] [Indexed: 12/29/2022] Open
Abstract
In renal transplanted patients, lymphoceles and lymphorrhea are well-known lymphatic complications. Surgical damage of the lymphatics of the graft during the procurement and of the lymphatic around the iliac vessels of the recipients has been associated with development of lymphatic complications. However, lymphatic complications may be related to medical factors such as diabetes, obesity, blood coagulation abnormalities, anticoagulation prophylaxis, high dose of diuretics, delay in graft function and immunosuppressive drugs. Consistently, immunosuppression regimens based on the use of mTOR inhibitors, especially in association with steroids and immediately after transplantation, has been associated with a high risk to develop lymphocele or lymphorrhea. In addition, several studies have demonstrated the association between rejection episodes and lymphatic complications. However, before the discovery of reliable markers of lymphatic vessels, the pathogenic mechanisms underlining the development of lymphatic complications during rejection and the influence of mTOR inhibitors remained not fully understood. The recent findings on the lymphatic systems of either native or transplanted kidneys together with the advances achieved on lymphangiogenesis shared some lights on the pathogenesis of lymphatic complications after renal transplantation. In this review, we describe the surgical and medical causes of lymphatic complications focusing on the rejection and immunosuppressive drugs as causes of lymphatic complications.
Collapse
Affiliation(s)
- Andrea Ranghino
- Renal Transplantation Center 'A. Vercellone', Division of Nephrology Dialysis and Transplantation, Department of Medical Sciences , Città della Salute e della Scienza Hospital and University of Torino , Torino , Italy
| | - Giuseppe Paolo Segoloni
- Renal Transplantation Center 'A. Vercellone', Division of Nephrology Dialysis and Transplantation, Department of Medical Sciences , Città della Salute e della Scienza Hospital and University of Torino , Torino , Italy
| | - Fedele Lasaponara
- Division of Urology , Città della Salute e della Scienza Hospital , Torino , Italy
| | - Luigi Biancone
- Renal Transplantation Center 'A. Vercellone', Division of Nephrology Dialysis and Transplantation, Department of Medical Sciences , Città della Salute e della Scienza Hospital and University of Torino , Torino , Italy
| |
Collapse
|
12
|
Giuliani S, Gamba P, Kiblawi R, Midrio P, Ghirardo G, Zanon GF. Lymphocele after pediatric kidney transplantation: incidence and risk factors. Pediatr Transplant 2014; 18:720-5. [PMID: 25163815 DOI: 10.1111/petr.12341] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/23/2014] [Indexed: 11/30/2022]
Abstract
Lymphocele is a well-known postoperative complication after kidney transplantation. The aim of this study was to analyze time trend incidence, risk factors, and outcome of post-transplant lymphocele in a large pediatric cohort. This is a retrospective single institution review of 241 pediatric kidney transplants performed from 2000 to 2013. Etiology of end-stage renal disease, recipient age and gender, transplant year, BMI percentile for age, type of dialysis, living/non-living related donor, acute rejection, and multiple transplantations were analyzed in association with lymphocele formation. Fourteen of 241 (5.81%) children developed a postoperative lymphocele. There has been a reduction in the incidence of lymphocele after 2006 (3.22% vs. 8.55%, p < 0.05). Significant risk factors for lymphocele were older age (≥11 yr), transplant before 2006, male gender, BMI percentile for age ≥95%, and multiple transplantations (p < 0.05). The one-yr graft survival was significantly reduced in the group with lymphocele compared with control (81.2% vs. 92.51%, p < 0.04). This is the first pediatric report showing the following risk factors associated with post-transplant lymphocele: age ≥11 yr, male gender, BMI for age ≥95%, and multiple transplantations. A lymphocele can contribute to graft loss in the first-year post-transplant.
Collapse
Affiliation(s)
- Stefano Giuliani
- Department of Pediatric & Neonatal Surgery, St George's Healthcare NHS Trust and University, London, UK; Division of Pediatric Surgery, Department of 'Salute della Donna e del Bambino', University of Padova, Padova, Italy
| | | | | | | | | | | |
Collapse
|