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Takahashi H, Inoue A, Tanaka T, Sato Y, Potretzke TA, Masuoka S, Takahashi N, Minami M, Kawashima A. Imaging of Perirenal and Intrarenal Lymphatic Vessels: Anatomy-based Approach. Radiographics 2024; 44:e230065. [PMID: 38386603 DOI: 10.1148/rg.230065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
The lymphatic system (or lymphatics) consists of lymphoid organs and lymphatic vessels. Despite the numerous previously published studies describing conditions related to perirenal and intrarenal lymphoid organs in the radiology literature, the radiologic findings of conditions related to intrarenal and perirenal lymphatic vessels have been scarcely reported. In the renal cortex, interlobular lymphatic capillaries do not have valves; therefore, lymph can travel along the primary route toward the hilum, as well as toward the capsular lymphatic plexus. These two lymphatic pathways can be opacified by contrast medium via pyelolymphatic backflow at CT urography, which reflects urinary contrast agent leakage into perirenal lymphatic vessels via forniceal rupture. Pyelolymphatic backflow toward the renal hilum should be distinguished from urinary leakage due to urinary injury. Delayed subcapsular contrast material retention via pyelolymphatic backflow, appearing as hyperattenuating subcapsular foci on CT images, mimics other subcapsular cystic diseases. In contrast to renal parapelvic cysts originating from the renal parenchyma, renal peripelvic cysts are known to be of lymphatic origin. Congenital renal lymphangiectasia is mainly seen in children and assessed and followed up at imaging. Several lymphatic conditions, including lymphatic leakage as an early complication and acquired renal lymphangiectasia as a late complication, are sometimes identified at imaging follow-up of kidney transplant. Lymphangiographic contrast material accumulation in the renal hilar lymphatic vessels is characteristic of chylo-urinary fistula. Chyluria appears as a fat-layering fluid-fluid level in the urinary bladder or upper urinary tract. Recognition of the anatomic pathway of tumor spread via lymphatic vessels at imaging is of clinical importance for accurate management at oncologic imaging. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.
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Affiliation(s)
- Hiroaki Takahashi
- From the Department of Radiology (H.T., A.I., T.A.P., N.T.) and Department of Medicine, Division of Rheumatology (Y.S.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Radiology, Okayama City Hospital, Okayama, Japan (T.T.); Department of Radiology, Jichi Medical University, Tochigi, Japan (S.M.); Department of Diagnostic and Interventional Radiology, University of Tsukuba, Ibaraki, Japan (M.M.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (A.K.)
| | - Akitoshi Inoue
- From the Department of Radiology (H.T., A.I., T.A.P., N.T.) and Department of Medicine, Division of Rheumatology (Y.S.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Radiology, Okayama City Hospital, Okayama, Japan (T.T.); Department of Radiology, Jichi Medical University, Tochigi, Japan (S.M.); Department of Diagnostic and Interventional Radiology, University of Tsukuba, Ibaraki, Japan (M.M.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (A.K.)
| | - Takashi Tanaka
- From the Department of Radiology (H.T., A.I., T.A.P., N.T.) and Department of Medicine, Division of Rheumatology (Y.S.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Radiology, Okayama City Hospital, Okayama, Japan (T.T.); Department of Radiology, Jichi Medical University, Tochigi, Japan (S.M.); Department of Diagnostic and Interventional Radiology, University of Tsukuba, Ibaraki, Japan (M.M.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (A.K.)
| | - Yuki Sato
- From the Department of Radiology (H.T., A.I., T.A.P., N.T.) and Department of Medicine, Division of Rheumatology (Y.S.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Radiology, Okayama City Hospital, Okayama, Japan (T.T.); Department of Radiology, Jichi Medical University, Tochigi, Japan (S.M.); Department of Diagnostic and Interventional Radiology, University of Tsukuba, Ibaraki, Japan (M.M.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (A.K.)
| | - Theodora A Potretzke
- From the Department of Radiology (H.T., A.I., T.A.P., N.T.) and Department of Medicine, Division of Rheumatology (Y.S.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Radiology, Okayama City Hospital, Okayama, Japan (T.T.); Department of Radiology, Jichi Medical University, Tochigi, Japan (S.M.); Department of Diagnostic and Interventional Radiology, University of Tsukuba, Ibaraki, Japan (M.M.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (A.K.)
| | - Sota Masuoka
- From the Department of Radiology (H.T., A.I., T.A.P., N.T.) and Department of Medicine, Division of Rheumatology (Y.S.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Radiology, Okayama City Hospital, Okayama, Japan (T.T.); Department of Radiology, Jichi Medical University, Tochigi, Japan (S.M.); Department of Diagnostic and Interventional Radiology, University of Tsukuba, Ibaraki, Japan (M.M.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (A.K.)
| | - Naoki Takahashi
- From the Department of Radiology (H.T., A.I., T.A.P., N.T.) and Department of Medicine, Division of Rheumatology (Y.S.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Radiology, Okayama City Hospital, Okayama, Japan (T.T.); Department of Radiology, Jichi Medical University, Tochigi, Japan (S.M.); Department of Diagnostic and Interventional Radiology, University of Tsukuba, Ibaraki, Japan (M.M.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (A.K.)
| | - Manabu Minami
- From the Department of Radiology (H.T., A.I., T.A.P., N.T.) and Department of Medicine, Division of Rheumatology (Y.S.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Radiology, Okayama City Hospital, Okayama, Japan (T.T.); Department of Radiology, Jichi Medical University, Tochigi, Japan (S.M.); Department of Diagnostic and Interventional Radiology, University of Tsukuba, Ibaraki, Japan (M.M.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (A.K.)
| | - Akira Kawashima
- From the Department of Radiology (H.T., A.I., T.A.P., N.T.) and Department of Medicine, Division of Rheumatology (Y.S.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Radiology, Okayama City Hospital, Okayama, Japan (T.T.); Department of Radiology, Jichi Medical University, Tochigi, Japan (S.M.); Department of Diagnostic and Interventional Radiology, University of Tsukuba, Ibaraki, Japan (M.M.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (A.K.)
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Acikgoz O, Akinci S. Comparison of Bipolar Electrocautery-Based Vascular Sealers with Conventional Ligation in Iliac Vessel Preparation of Renal Transplant Recipients. Transplant Proc 2023:S0041-1345(23)00208-7. [PMID: 37130767 DOI: 10.1016/j.transproceed.2023.03.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/26/2023] [Accepted: 03/27/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND Post-transplant lymphocele is a common complication with a potentially severe course and may require percutaneous drainage or open/percutaneous surgical intervention. Closure of the lymphatics around the iliac vessels is paramount in avoiding lymphocele formation. This study aimed to evaluate the effectiveness of bipolar electrocautery-based vascular sealers (BSD) in the dissection and/or ligation of lymphatic vessels in terms of the development of lymphoceles and postoperative kidney functions in live donor kidney transplants at our center. METHODS A total of 63 patients who underwent kidney transplantation (KTx) between January and December 2021 were included in the study. Data, including postoperative creatinine values and postoperative ultrasonography follow-up, were recorded. Thirty-seven patients who were operated on using conventional ligation for iliac vessel preparation were included in group 1. Twenty-six patients treated using BSD for iliac vessel preparation were included in group 2. Statistical analysis was performed to compare these groups. This study complied with The Helsinki Congress and The Declaration of Istanbul. RESULTS There was no significant difference between the groups in terms of postoperative first-week creatinine values (1.176 mg/dL vs 1.203 mg/dL), first-month creatinine values (1.061 mg/dL vs 1.091 mg/dL), first-week collection volume (33.240 mL vs 33.430 mL), and third-month collection volume (23.120 mL vs 23.430 mL) (P > .05). CONCLUSIONS In KTx surgery, BSD is as safe as and faster than conventional ligation in preparation of the recipient's iliac vessels.
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Affiliation(s)
- Onur Acikgoz
- Urology and Organ Transplantation Department, Memorial Hizmet Hospital, Istanbul, Turkey.
| | - Serkan Akinci
- Urology and Organ Transplantation Department, Memorial Hizmet Hospital, Istanbul, Turkey
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Beau M, Barbieux J, Bigot P, Piquet J, Aupert G, Duveau A, Lebdai S, Planchais M, Augusto JF, Culty T. Study of Post-Kidney Transplantation Parietal Complications and Presarcopenia. Transplant Proc 2023; 55:116-122. [PMID: 36564320 DOI: 10.1016/j.transproceed.2022.10.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/12/2022] [Accepted: 10/18/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Sarcopenia is defined as a loss of muscle mass and strength. Its effects on postoperative outcomes in oncology and geriatrics have already been shown. Approximately 40% of patients in end-stage renal failure are affected with sarcopenia. A recent study suggests that sarcopenia could predict surgical complications after renal transplantation in obese patients. The aim of this study was to evaluate the effect of sarcopenia on parietal complications (eg, wound healing, lymphocele, hematoma). METHODS Two indices of muscle fat infiltration (intra-muscular adipose content [IMAC], Hounsfield unit average calculation [HUAC]) and 3 of muscle mass index (total psoas index [TPI], visceral fat area/total abdominal muscle area [VFA/TAMA], and skeletal muscle mass index [SMMI]) were retrospectively measured on pretransplant computed tomography scans for patients undergoing kidney transplantation between 2007 and 2017. Patients were considered sarcopenic when the index was above the third quartile for muscle fat infiltration (IMAC, HUAC) and VFA/TAMA, and under the first quartile for muscle mass (TPI, SMMI). The occurrence of wound healing, collection (hematoma and lymphocele), and acute rejection were compared between sarcopenic and nonsarcopenic patients. RESULTS Of 484 transplanted patients, 117 patients had a computed tomography scan before transplantation. Patients with a high HUAC had significantly more collections (P = .02) and total parietal complications (P = .09). Patients with a high IMAC had significantly more acute rejection (P = .001). CONCLUSIONS Muscle fat infiltration appears to influence the outcome of renal transplantation. The management of sarcopenia in pretransplantation should be a subject of further research.
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Affiliation(s)
- Marion Beau
- Service urologie, Centre Hospitalier Universitaire, Angers, France.
| | - Julien Barbieux
- Service de chirurgie visceral, Centre Hospitalier, Le Mans, France
| | - Pierre Bigot
- Service urologie, Centre Hospitalier Universitaire, Angers, France
| | - Jean Piquet
- Service chirurgie vasculaire et thoracique, Centre Hospitalier Universitaire, Angers, France
| | - Gauthier Aupert
- Service chirurgie vasculaire et thoracique, Centre Hospitalier Universitaire, Angers, France
| | - Agnes Duveau
- Service de néphrologie, Centre Hospitalier Universitaire, Angers, France
| | - Souhil Lebdai
- Service urologie, Centre Hospitalier Universitaire, Angers, France
| | - Martin Planchais
- Service de néphrologie, Centre Hospitalier Universitaire, Angers, France
| | | | - Thibaut Culty
- Service urologie, Centre Hospitalier Universitaire, Angers, France
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Liu HT, Liu CA, Wang HK, Liu CS, Shen SH. Minimal invasive treatment for post-liver and renal transplant lymphatic leaks. Clin Transplant 2022; 36:e14691. [PMID: 35485283 DOI: 10.1111/ctr.14691] [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: 10/28/2021] [Revised: 04/13/2022] [Accepted: 04/23/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Persistent lymphatic leakage from the surgical drain is a troubling complication occasionally encountered postoperatively. This study investigated lymphatic leaks after renal or liver transplantation, comparing the treatment efficacy of traditional catheter drainage vs. minimally invasive lymphatic interventions. We also discuss access and treatment targets considering the physiology of lymphatic flow. METHODS Between September 2018 and September 2020, 13 patients with lymphatic leakage were treated with minimally invasive lymphatic interventions; 11 had received a renal transplant, and two received a liver transplant. The control group included 10 patients with post-renal transplant lymphatic leakage treated with catheter drainage. The treatment efficacy of catheter drainage, lymphatic interventions, and different targets of embolization were compared. RESULTS The technical success rate for lymphatic intervention was 100%, and the clinical success rate was 92%, with an 82.9% percent reduction in drain volume on the first day after treatment. The duration to reach clinical success was 5.9 days with lymphatic intervention, and 33.9 days with conservative catheter drainage. CONCLUSION Lymphangiography and embolization are minimally invasive and efficient procedures for treating persistent lymphatic leaks after renal or liver transplantation. We suggest prompt diagnosis and embolization at upstream lymphatics to reduce the duration of drain retention, days of hospitalization and associated comorbidities. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Hsien-Tzu Liu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Radiology, Shuang-Ho Hospital, Taiwan, New Taipei City, Taiwan.,National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chien-An Liu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan.,National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hsin-Kai Wang
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan.,National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chin-Su Liu
- National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Transplantation Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shu-Huei Shen
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan.,National Yang Ming Chiao Tung University, Taipei, Taiwan
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Isiktas Sayilar E, Ersoy A, Ayar Y, Aydin MF, Sahin AB, Coskun B, Kaygisiz O, Yildiz A, Kordan Y, Vuruskan H. Factors Influencing Lymphocele Development After Kidney Transplant: Single Center Experience. EXP CLIN TRANSPLANT 2022; 21:116-122. [PMID: 31250740 DOI: 10.6002/ect.2018.0293] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Lymphocele is a well-known postoperative surgical complication after kidney transplant. In this study, our aim was to analyze incidence, risk factors, and outcomes of posttransplant lymphocele in a large cohort. MATERIALS AND METHODS This observational study included 395 consecutive patients (219 males and 176 females) who underwent kidney transplant procedures from 183 living and 212 deceased donors in our center between January 2007 and 2014. A lymphocele was diagnosed with ultrasonography. RESULTS The incidence of lymphoceles in our cohort was 31.9% (n = 126). There were no significant dif-ferences with regard to body mass indexes, age of donors, deceased donor ratios, acute rejection episodes, and history of abdominal surgery between those with and without lymphoceles. The pre-transplant serum albumin levels (3.29 ± 0.67 vs 3.48 ± 0.69 g/dL; P = .009) in the lymphocele group and diabetes mellitus ratios (15.9% vs 4.5%; P < .001) in the nonlymphocele group were lower than levels shown in the other group. The lymphocele ratio in patients who received cyclosporine was higher than that shown in patients who did not received it (37.5% vs. 27.4%; P = .032). There was no difference in lymphocele incidence between patients who were taking and those who were not taking mammalian target of rapamycin inhibitors, mycophenolate mofetil, or mycophenolate sodium. In regression analysis, presence of diabetes mellitus, transplant from deceased donors, older age of donors, and lower albumin levels were independent risk factors for posttransplant lymphocele occurrence. CONCLUSIONS Posttransplant lymphocele was a relatively common surgical complication in our cohort. We concluded that diabetes mellitus, use of kidneys from deceased donors, older donor age, and hypoalbuminemia were independent risk factors for lymphocele development.
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Affiliation(s)
- Emel Isiktas Sayilar
- From the Department of Nephrology, Uludag University Faculty of Medicine, Bursa, Turkey
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Park YJ, Mok SK, Kim JY, Yun SS, Park SC. Retroperitoneal Viscum album extract instillation in patients with a large amount of drainage after kidney transplantation. Ann Surg Treat Res 2021; 101:368-373. [PMID: 34934764 PMCID: PMC8651988 DOI: 10.4174/astr.2021.101.6.368] [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: 06/04/2021] [Revised: 09/10/2021] [Accepted: 10/07/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose After kidney transplantation (KT), a large amount of drainage can delay postoperative recovery. Viscum album extract is an agent used in pleurodesis, and the purpose of this study was to evaluate the efficacy of this agent in reducing the amount of drainage after KT. Methods Medical records of patients with a large amount of drainage (≥ 100 mL/day) on postoperative day (POD) 7 after KT who had undergone V. album extract instillation through drainage tube (n = 115) or conservative management (n = 177) were retrospectively reviewed. The primary endpoint was a decrease in the amount of drainage on POD 14 from POD 7. Results A decrease in the amount of drainage on POD 14 from POD 7 was larger in the V. album extract instillation group than in the conservative management group (–228.3 ± 181.6 mL vs. –144.6 ± 202.0 mL, P < 0.001). Duration of hospitalization after operation was shorter in the V. album extract instillation group than in the conservative management group (15.9 ± 3.2 days vs. 18.1 ± 5.3 days, P < 0.001). In multivariate analysis, there was a statistically significant association of V. album extract instillation with lower risk of persistent large amount of drainage (≥ 100 mL/day on POD 14), with an odds ratio of 0.57 (95% confidence interval, 0.35–0.93; P = 0.026). Conclusion Retroperitoneal V. album extract instillation could be effective in reducing the amount of drainage and promoting postoperative recovery in patients with a large amount of drainage after KT.
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Affiliation(s)
- Young Jun Park
- Department of Vascular and Transplant Surgery, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea
| | - Sang Kyun Mok
- Department of Vascular and Transplant Surgery, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea
| | - Jang Yong Kim
- Department of Vascular and Transplant Surgery, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea
| | - Sang Seob Yun
- Department of Vascular and Transplant Surgery, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea
| | - Sun Cheol Park
- Department of Vascular and Transplant Surgery, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea
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Validating Consensus-Defined Severity Grading of Lymphatic Complications after Kidney Transplant. J Clin Med 2021; 10:jcm10214858. [PMID: 34768377 PMCID: PMC8584504 DOI: 10.3390/jcm10214858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 10/15/2021] [Accepted: 10/19/2021] [Indexed: 11/17/2022] Open
Abstract
Lymphatic complications after kidney transplantation (KTx) are associated with morbidities such as impaired wound healing, thrombosis, and organ failure. Recently, a consensus regarding the definition and severity grading of lymphoceles has been suggested. The aim of the present study was to validate this classification method. All adult patients who underwent KTx between December 2011 and September 2016 in our department were evaluated regarding lymphoceles that were diagnosed within 6 months after KTx based on the recent definition. Patients with lymphoceles were categorized according to the classification criteria, and clinical outcomes were compared between the groups. In our department, a total of 587 patients underwent KTx between 2011 and 2016. Lymphoceles were detected after KTx in 90 patients (15.3%). Among these patients, 24 (26.6%) had grade A lymphoceles, 14 (15.6%) had grade B, and 52 (57.8%) had grade C. The median duration times of intermediate care (IMC) and hospital stay were significantly higher among patients with grade C lymphoceles than they were among patients with grade A and B lymphoceles. Significantly more patients with grade C lymphoceles were readmitted to the hospital for treatment. The recently published definition and severity grading of lymphoceles after KTx is an easy-to-use and valid classification system, which may facilitate the comparison of results from different studies on lymphoceles after KTx.
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Agarwal N, Kumar GR, Singh Rana AK, Mubeen A, Dokania MK. Predictors of Lymphatic Complications Following Renal Transplant: A Prospective Study Involving Predominantly Living Donor Transplants From India. Cureus 2021; 13:e17133. [PMID: 34532172 PMCID: PMC8437002 DOI: 10.7759/cureus.17133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction Lymphatic complications (LC) are common (up to 33%) and troublesome after renal transplantation. Different studies have established varying medical and surgical risk factors, mostly by retrospective analysis on deceased donor renal transplants (DDRTs). The end-point is mostly lymphocele, with few reports documenting the equally important lymphorrhea. Methods In our prospective analytical study done over three years, most were living donor renal transplant (LDRT) pairs by a single team. The primary outcome measure was lymphocele and/or prolonged drainage for more than 15 days, with a six-month follow-up. The variables recorded were age, gender, hemodialysis duration, etiology, relationship, human leucocyte antigen (HLA) mismatch, induction regimen, acute rejection, warm ischemia time (WIT), and delayed graft function (DGF). Univariate analysis was by chi-square and t-tests as applicable, while logistic regression (both simultaneous and forward stepwise) was used for risk factor prediction. Results Eligible cases were 150, with 145 (97%) LDRT pairs. Donors were mostly female (122/150; 81%) with mean age (~43 years) higher than recipient age (~33 years). The common etiologies were diabetes (31%), hypertension (23%), and IgA nephropathy (11%). Most donors were mothers (37%) and wives (31%), and 28% of LDRT pairs had HLA mismatch >3. Mean duration of hemodialysis was about 18 months, and mean WIT was 52 minutes. Both DGF (B coefficient= -1.69, p<0.000) and WIT (B=-0.038, p=0.024) were significant predictors of the primary outcome, while drain removal before 15 days predicted lymphocele significantly (B=-2.4, p<0.000). Conclusions LDRT has specific risk factors for lymphatic complications, which may be related to extent of recipient vascular dissection, arterial anastomotic time, and early drain removal.
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Affiliation(s)
- Nitin Agarwal
- Transplant Unit, Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences and Ram Manohar Lohia Hospital, Delhi, IND
| | - Gyan R Kumar
- Transplant Unit, Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences and Ram Manohar Lohia Hospital, Delhi, IND
| | - Anil K Singh Rana
- Transplant Unit, Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences and Ram Manohar Lohia Hospital, Delhi, IND
| | - Abdul Mubeen
- Transplant Unit, Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences and Ram Manohar Lohia Hospital, Delhi, IND
| | - Manoj K Dokania
- Transplant Unit, Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences and Ram Manohar Lohia Hospital, Delhi, IND
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9
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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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Deininger S, Nadalin S, Amend B, Guthoff M, Heyne N, Königsrainer A, Strohäker J, Stenzl A, Rausch S. Minimal-invasive management of urological complications after kidney transplantation. Int Urol Nephrol 2021; 53:1267-1277. [PMID: 33655463 PMCID: PMC8192401 DOI: 10.1007/s11255-021-02825-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/19/2021] [Indexed: 11/25/2022]
Abstract
Kidney transplantation represents the gold standard treatment option for patients with end-stage renal disease. Improvements in surgical technique and pharmacologic treatment have continuously prolonged allograft survival in recent years. However, urological complications are frequently observed, leading to both postoperative morbidity and putative deterioration of allograft function. While open redo surgery in these patients is often accompanied by elevated surgical risk, endoscopic management of urological complications is an alternative, minimal-invasive option. In the present article, we reviewed the literature on relevant urological postoperative complications after kidney transplantation and describe preventive approaches during the pre-transplantation assessment and their management using minimal-invasive approaches.
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Affiliation(s)
- Susanne Deininger
- Department of Urology, University Hospital Tübingen, Eberhard Karls University, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
- Department of Urology and Andrology, Salzburg University Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Silvio Nadalin
- Department of General and Transplant Surgery, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Bastian Amend
- Department of Urology, University Hospital Tübingen, Eberhard Karls University, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Martina Guthoff
- Department of Internal Medicine IV, Section of Nephrology and Hypertension, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Nils Heyne
- Department of Internal Medicine IV, Section of Nephrology and Hypertension, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Alfred Königsrainer
- Department of General and Transplant Surgery, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Jens Strohäker
- Department of General and Transplant Surgery, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Arnulf Stenzl
- Department of Urology, University Hospital Tübingen, Eberhard Karls University, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Steffen Rausch
- Department of Urology, University Hospital Tübingen, Eberhard Karls University, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany.
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11
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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: 3] [Impact Index Per Article: 1.0] [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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12
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Shokeir AA, Hassan S, Shehab T, Ismail W, Saad IR, Badawy AA, Sameh W, Hammouda HM, Elbaz AG, Ali AA, Barsoum R. Egyptian clinical practice guideline for kidney transplantation. Arab J Urol 2021; 19:105-122. [PMID: 34104484 PMCID: PMC8158205 DOI: 10.1080/2090598x.2020.1868657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Objective: To present the first Egyptian clinical practice guideline for kidney transplantation (KT). Methods: A panel of multidisciplinary subspecialties related to KT prepared this document. The sources of information included updates of six international guidelines, and review of several relevant international and Egyptian publications. All statements were graded according to the strength of clinical practice recommendation and the level of evidence. All recommendations were discussed by the panel members who represented most of the licensed Egyptian centres practicing KT. Results: Recommendations were given on preparation, surgical techniques and surgical complications of both donors and recipients. A special emphasis was made on the recipient’s journey with immunosuppression. It starts with setting the scene by covering the donor and recipient evaluations, medicolegal requirements, recipient’s protective vaccines, and risk assessment. It spans desensitisation and induction strategies to surgical approach and potential complications, options of maintenance immunosuppression, updated treatment of acute rejection and chemoprophylactic protocols. It ends with monitoring for potential complications of the recipient’s suppressed immunity and the short- and long-term complications of immunosuppressive drugs. It highlights the importance of individualisation of immunosuppression strategies consistent with pre-KT risk assessment. It emphasises the all-important role of anti-human leucocyte antigen antibodies, particularly the donor-specific antibodies (DSAs), in acute and chronic rejection, and eventual graft and patient survival. It addresses the place of DSAs across the recipient’s journey with his/her gift of life. Conclusion: This guideline introduces the first proposed standard of good clinical practice in the field of KT in Egypt. Abbreviations: Ab: antibody; ABMR: Ab-mediated rejection; ABO: ABO blood groups; BKV: BK polyomavirus; BMI: body mass index; BTS: British Transplantation Society; CAN: chronic allograft nephropathy; CDC: complement-dependent cytotoxicity; CKD: chronic kidney disease; CMV: cytomegalovirus; CNI: calcineurin inhibitor; CPRA: Calculated Panel Reactive Antibodies; (dn)DSA: (de novo) donor-specific antibodies; ECG: electrocardiogram; ESWL: extracorporeal shockwave lithotripsy; FCM: flow cytometry; GBM: glomerular basement membrane; GN: glomerulonephritis; HIV: human immunodeficiency virus; HLA: human leucocyte antigen; HPV: human papilloma virus; IL2-RA: interleukin-2 receptor antagonist; IVIg: intravenous immunoglobulin; KT(C)(R): kidney transplantation/transplant (candidate) (recipient); (L)(O)LDN: (laparoscopic) (open) live-donor nephrectomy; MBD: metabolic bone disease; MCS: Mean channel shift (in FCM-XM); MFI: mean fluorescence intensity; MMF: mycophenolate mofetil; mTOR(i): mammalian target of rapamycin (inhibitor); NG: ‘not graded’; PAP: Papanicolaou smear; PCN: percutaneous nephrostomy; PCNL: percutaneous nephrolithotomy; PKTU: post-KT urolithiasis; PLEX: plasma exchange; PRA: panel reactive antibodies; PSI: proliferation signal inhibitor; PTA: percutaneous transluminal angioplasty; RAS: renal artery stenosis; RAT: renal artery thrombosis;:rATG: rabbit anti-thymocyte globulin; RCT: randomised controlled trial; RIS: Relative MFI Score; RVT: renal vein thrombosis; TB: tuberculosis; TCMR: T-cell-mediated rejection; URS: ureterorenoscopy; (CD)US: (colour Doppler) ultrasonography; VCUG: voiding cystourethrogram; XM: cross match; ZN: Ziehl–Neelsen stain
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Affiliation(s)
- Ahmed A Shokeir
- Urology and Nephrology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | | | - Tamer Shehab
- Nephrology Department, Al-Sahel Teaching Hospital, Cairo, Egypt
| | - Wesam Ismail
- Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Ismail R Saad
- Urology Department, Kasr El-Einy Medical School, Cairo University, Cairo, Egypt
| | | | - Wael Sameh
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | | | - Ahmed G Elbaz
- Urology Department, Theodor Bilharz Research Institute, El Warraq, Giza, Egypt
| | - Ayman A Ali
- Urology Department, Theodor Bilharz Research Institute, El Warraq, Giza, Egypt
| | - Rashad Barsoum
- Nephrology Department, Kasr El-Einy Medical School, Cairo University, Cairo, Egypt
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13
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Treatment of symptomatic postoperative pelvic lymphoceles: A systematic review. Eur J Radiol 2020; 134:109459. [PMID: 33302026 DOI: 10.1016/j.ejrad.2020.109459] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 11/10/2020] [Accepted: 11/30/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE A broad range of therapeutic options exists for symptomatic postoperative lymphoceles. However, no consensus exists on what is the optimal therapy. In this study, we aimed to compare the efficacy of currently available radiologic interventions in terms of number of successful interventions, number of recurrences, and number of complications. METHODS A systematic review was conducted with a pre-defined search strategy for PubMed, EMBASE, and Cochrane databases from inception until September 2019. Quality assessment was performed using the 'Risk Of Bias In Non-randomized Studies - of Interventions' tool. Statistical heterogeneity was assessed using the I2 and χ2 test and a meta-analysis was considered for studies reporting on multiple interventions. RESULTS 37 eligible studies including 732 lymphoceles were identified. Proportions of successful interventions for percutaneous fine needle aspiration, percutaneous catheter drainage, percutaneous catheter drainage with delayed or instantaneous addition of sclerotherapy, and embolization were as follows: 0.341 (95% confidence interval [CI]: 0.185-0.542), 0.612 (95% CI: 0.490-0.722), 0.890 (95% CI: 0.781-0.948), 0.872 (95% CI: 0.710-0.949), 0.922 (95% CI: 0.731-0.981). Random-effects meta-analysis of seven studies revealed a pooled relative risk for percutaneous catheter drainage with delayed addition of sclerotherapy of 1.57 (95% CI: 1.17-2.10) when compared to percutaneous catheter drainage alone. The risk of bias in this study was severe. CONCLUSIONS This systematic review demonstrates that the success rates of percutaneous catheter drainage with sclerotherapy are more favorable when compared to percutaneous catheter drainage alone in the treatment of postoperative pelvic lymphoceles. Overall, percutaneous catheter drainage with delayed addition of sclerotherapy, and embolization showed the best outcomes.
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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: 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.
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15
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Golriz M, Sabagh M, Mohammadi S, Ghamarnejad O, Khajeh E, Mieth M, Al-Saeedi M, Diener MK, Mihaljevic AL, Morath C, Zeier M, Kulu Y, Mehrabi A. PREventive effect of FENestration with and without clipping on post-kidney transplantation lymphatic complications (PREFEN): study protocol for a randomised controlled trial. BMJ Open 2020; 10:e032286. [PMID: 33051226 PMCID: PMC7554503 DOI: 10.1136/bmjopen-2019-032286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Peritoneal fenestration is an effective preventive method for reducing the rate of lymphatic complications in kidney transplantation (KTx). The size of the fenestration plays an important role in its effectiveness. A large peritoneal window is no longer indicated, due to herniation and difficulties in performing biopsies. Small preventive fenestration is effective but will be closed too early. The aim of this study is to evaluate whether metal clips around the edges of a small fenestration result in optimal effects with minimum fenestration size. METHODS AND ANALYSIS This trial has been initiated in July 2019 and is expected to last for 2 and a half years. All patients older than 18 years, who receive kidneys from deceased donors, will be included. The kidney recipients will be randomly allocated to either a control arm (small fenestration alone) or an intervention arm (small fenestration with clipping). All fenestrations will be round, maximum 2 cm, and close to the kidney hilum. Clipping will be performed with eight metal clips around the peritoneal window (360°) in every 45° in an oblique position. The primary endpoint is the incidence of symptomatic post-KTx lymphatic complications, which require interventional treatment within 6 months after KTx. Secondary endpoints are intraoperative and postoperative outcomes, including blood loss, operation time, severity grade of lymphocele/lymphorrhea and relative symptoms. ETHICS AND DISSEMINATION This protocol study received approval from the Ethics Committee of the University of Heidelberg (Registration Number S-318/2017). A Standard Protocol Items: Recommendations for Interventional Trials checklist is available for this protocol. The results will be disseminated through peer-reviewed journals and conference presentations. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT03682627).
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Affiliation(s)
- Mohammad Golriz
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Baden-Württemberg, Germany
| | - Mohammadsadegh Sabagh
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Baden-Württemberg, Germany
| | - Sara Mohammadi
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Baden-Württemberg, Germany
| | - Omid Ghamarnejad
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Baden-Württemberg, Germany
| | - Elias Khajeh
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Baden-Württemberg, Germany
| | - Markus Mieth
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Baden-Württemberg, Germany
| | - Mohammed Al-Saeedi
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Baden-Württemberg, Germany
| | - Markus K Diener
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Baden-Württemberg, Germany
| | - André L Mihaljevic
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Baden-Württemberg, Germany
| | - Christian Morath
- Department of Nephrology, Heidelberg University Hospital, Heidelberg, Germany
| | - Martin Zeier
- Department of Nephrology, Heidelberg University Hospital, Heidelberg, Germany
| | - Yakup Kulu
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Baden-Württemberg, Germany
| | - Arianeb Mehrabi
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Baden-Württemberg, Germany
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16
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Analysis of Risk Factors and Long-Term Outcomes in Kidney Transplant Patients with Identified Lymphoceles. J Clin Med 2020; 9:jcm9092841. [PMID: 32887366 PMCID: PMC7563120 DOI: 10.3390/jcm9092841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/24/2020] [Accepted: 08/29/2020] [Indexed: 11/22/2022] Open
Abstract
The collection of lymphatic fluids (lymphoceles) is a frequent adverse event following renal transplantation. A variety of surgical and medical factors has been linked to this entity, but reliable data on risk factors and long-term outcomes are lacking. This retrospective single-center study included 867 adult transplant recipients who received a kidney transplantation from 2006 to 2015. We evaluated for patient and graft survival, rejection episodes, or detectable donor-specific antibodies (dnDSA) in patients with identified lymphoceles in comparison to controls. We identified 305/867 (35.2%) patients with lymphocele formation, of whom 72/867 (8.3%) needed intervention. Multivariate analysis identified rejection episode as an independent risk factor (OR 1.61, CI 95% 1.17–2.21, p = 0.003) for lymphocele formation, while delayed graft function was independently associated with symptomatic lymphoceles (OR 1.9, CI 95% 1.16–3.12, p = 0.011). Interestingly, there was no difference in detectable dnDSA between groups with a similar graft and patient survival in all groups after 10 years. Lymphoceles frequently occur after transplantation and were found to be independently associated with rejection episodes, while symptomatic lymphoceles were associated with delayed graft function in our cohort. As both are inflammatory processes, they might play a causative role in the formation of lymphoceles. However, development or intervention of lymphoceles did not lead to impaired graft survival in the long-term.
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17
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Mehrabi A, Kulu Y, Sabagh M, Khajeh E, Mohammadi S, Ghamarnejad O, Golriz M, Morath C, Bechstein WO, Berlakovich GA, Demartines N, Duran M, Fischer L, Gürke L, Klempnauer J, Königsrainer A, Lang H, Neumann UP, Pascher A, Paul A, Pisarski P, Pratschke J, Schneeberger S, Settmacher U, Viebahn R, Wirth M, Wullich B, Zeier M, Büchler MW. Consensus on definition and severity grading of lymphatic complications after kidney transplantation. Br J Surg 2020; 107:801-811. [PMID: 32227483 DOI: 10.1002/bjs.11587] [Citation(s) in RCA: 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.
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Affiliation(s)
- A Mehrabi
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Y Kulu
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - M Sabagh
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - E Khajeh
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - S Mohammadi
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - O Ghamarnejad
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - M Golriz
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - C Morath
- Division of Nephrology, Heidelberg University Hospital, Heidelberg, Germany
| | - W O Bechstein
- Department of General and Visceral Surgery, Frankfurt University Hospital, Goethe University, Frankfurt am Main, Germany
| | - G A Berlakovich
- Division of Transplantation, Department of Surgery, Vienna Medical University, Vienna, Austria
| | - N Demartines
- Department of Visceral Surgery, CHUV University Hospital, Lausanne, Switzerland
| | - M Duran
- Department of Vascular and Endovascular Surgery, Düsseldorf University Hospital, Heinrich-Heine-University, Düsseldorf, Germany
| | - L Fischer
- Department of Visceral and Transplantation Surgery, Hamburg-Eppendorf University Hospital, Hamburg, Germany
| | - L Gürke
- Department of Vascular and Transplantation Surgery, Basel University Hospital, Basel, Switzerland
| | - J Klempnauer
- Department of General, Visceral, and Transplantation Surgery, Hannover Medical University, Hannover, Germany
| | - A Königsrainer
- Department of General, Visceral and Transplantation Surgery, Eberhard-Karls-University Hospital, Tübingen, Germany
| | - H Lang
- Department of General, Visceral and Transplantation Surgery, Johannes Gutenberg Medical University, Mainz, Germany
| | - U P Neumann
- Department of General, Visceral and Transplantation Surgery, RWTH University Hospital, Aachen, Germany
| | - A Pascher
- Department of General, Visceral and Transplantation Surgery, Münster University Hospital, Münster, Germany
| | - A Paul
- Department of General, Visceral and Transplantation Surgery, Essen University Hospital, Essen, Germany
| | - P Pisarski
- Department of General, Visceral and Surgery, Freiburg University Hospital, Freiburg, Germany
| | - J Pratschke
- Department of Surgery, Charité University Hospital, Berlin, Germany
| | - S Schneeberger
- Department of Visceral, Transplantation and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - U Settmacher
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Jena, Germany
| | - R Viebahn
- Department of Surgery, Knappschaftskrankenhaus University Hospital of Bochum, Ruhr University of Bochum, Bochum, Germany
| | - M Wirth
- Department of Urology, Carl Gustav Carus University Hospital, Dresden, Germany
| | - B Wullich
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Erlangen, Germany
| | - M Zeier
- Division of Nephrology, Heidelberg University Hospital, Heidelberg, Germany
| | - M W Büchler
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
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18
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Predictors of symptomatic lymphocele after kidney transplantation. Int Urol Nephrol 2019; 51:2161-2167. [PMID: 31486950 PMCID: PMC6848241 DOI: 10.1007/s11255-019-02269-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 08/28/2019] [Indexed: 12/28/2022]
Abstract
Purpose The development of a symptomatic lymphocele (SL) is a frequent postoperative surgical complication after kidney transplantation. It may lead to pain and discomfort and cause transplant malfunction or even secondary graft loss. A large cohort of renal recipients was investigated to identify the possible risk factors for SL. Methods All renal transplant patients of a single centre were retrospectively analysed for SL between January 2010 and December 2017. The SL group was compared to a control group from the same cohort. Results 45 out of 1003 transplanted patients developed an SL (incidence 4.5%), on average 50 days after kidney transplantation. SLs developed more in older patients, in those with a PD catheter and in ADKDP as primary diagnosis. Surgical predictors for SLs were venous anastomosis on the external iliac vein, concomitant PD catheter removal, perfusion defects, shorter operating time, splint > 7 days, double J stenting, discharge with drain, low initial drain production and ureteral obstruction. Opening of the peritoneum, re-operation for postoperative bleeding and previous nephrectomy seem protective for developing SL. Conclusion We found multiple heterogeneous predictors for SL with a common denominator related to surgical management of the retroperitoneal space, peritoneum and the ureter. Future prospective studies are necessary to evaluate the influence of these variables on the development of SL.
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19
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Jun H, Hwang SH. Diagnostic performance of multidetector computed tomography for symptomatic lymphoceles in kidney transplant recipients. KOREAN JOURNAL OF TRANSPLANTATION 2019; 33:30-35. [PMID: 35769147 PMCID: PMC9186869 DOI: 10.4285/jkstn.2019.33.2.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 05/08/2019] [Accepted: 05/10/2019] [Indexed: 11/04/2022] Open
Affiliation(s)
- Heungman Jun
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Sung Ho Hwang
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
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20
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Prophylactic Wound Drainage in Renal Transplantation: A Systematic Review. Transplant Direct 2019; 5:e468. [PMID: 31334342 PMCID: PMC6616136 DOI: 10.1097/txd.0000000000000908] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 04/20/2019] [Accepted: 04/25/2019] [Indexed: 12/26/2022] Open
Abstract
Background Adult kidney transplantation is most commonly into an extraperitoneal potential space, and surgically placed drains are used routinely in many centers. There is limited evidence of clinical benefit for prophylactic drainage in other major abdominal and vascular surgery. Transplantation is, however, a unique setting combining organ dysfunction and immunosuppression, and the risks and benefits of prophylactic drain placement are not known. This study attempts to examine existing literature to determine whether prophylactic intraoperative drains have an impact on the likelihood of perigraft fluid collections and other wound-related complications following kidney transplantation. Methods A literature search of MEDLINE and EMBASE was conducted to identify published comparative studies, including recipients receiving prophylactic drains to recipients in whom drains were omitted. The main outcomes were the incidence of peritransplant fluid collections and wound-related complications. Meta-analysis was performed on these data. Results Four retrospective cohort studies were deemed eligible for quantitative analysis and 1 additional conference abstract was included in qualitative discussion. A total of 1640 patients, 1023 with drains and 617 without, were included in the meta-analysis. There was a lower rate of peritransplant collections associated with the drain group (RR 0.62; 95% confidence interval, 0.42-0.90). There was no significant difference in the incidence of wound-related complications between the groups (RR 0.85; 95% confidence interval, 0.34-2.11). Conclusions These data associate a higher rate of peritransplant fluid collections with omission of prophylactic drainage, without a difference in the incidence of wound-related complications. Further research is required to definitively determine the impact of drains in this patient group.
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Abstract
Proper pre- and post-transplant diagnostic imaging work-up is fundamental in ensuring a successful outcome for renal transplantation. Despite exposure to ionizing radiation, CT has high spatial resolution and is a widely available and fast imaging technique. CT is performed routinely to delineate the anatomy of the kidney, relevant vasculature, and urinary collecting system in the living donor, to assess the iliac vessels in potential recipients prior to surgery, and to assess early and late-term post-transplant complications. The purpose of this article is to outline the optimal CT protocol and the main reportable findings for both the donor and the recipient diagnostic imaging work-up as well as to point out the main issues regarding ionizing radiation exposure and contrast medium injection in these subjects.
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22
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Burghuber CK, Kandioler D, Strobl S, Mittlböck M, Böhmig GA, Soliman T, Berlakovich GA. Standardized intraoperative application of an absorbable polysaccharide hemostatic powder to reduce the incidence of lymphocele after kidney transplantation - a prospective trial. Transpl Int 2018; 32:59-65. [PMID: 30099769 PMCID: PMC7380033 DOI: 10.1111/tri.13329] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 03/26/2018] [Accepted: 08/08/2018] [Indexed: 11/25/2022]
Abstract
We assessed whether standardized application of an absorbable polysaccharide hemostatic powder (HaemoCer™) has an effect on lymphocele rate after kidney transplantation. For this nonrandomized prospective trial, we first aimed to know our center‐specific lymphocele rate diagnosed by ultrasound imaging. We retrospectively assessed all patient records of the elapsed year resulting in a center‐specific rate of 20%, this was consistent with literature. The power analysis showed that 108 patients were required to detect a 50% reduction in lymphocele rate. During the prospective study period, 155 patients undergoing kidney transplantation were recruited to receive HaemoCer™ intraoperatively. In two patients, the product accidentally was not used. Six patients were excluded from analysis because of failure to complete follow‐up (one early death and five early graft failures). Of the remaining 147 patients, 15 developed lymphoceles, which represents a rate of 10.2%; (95% CI: 6.3–16.2%). Compared to the expected occurrence, this was significantly lower (P = 0.003). Lymphoceles appeared to be associated with preoperative donor‐specific antibody, retransplantation and immunoadsorption in HLA or ABO incompatible donors. At our institution, the frequency of lymphoceles after kidney transplantation appeared to be significantly reduced when HaemoCer™ was applied routinely. The magnitude of the effect warrants randomized evaluation.
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Affiliation(s)
- Christopher K Burghuber
- Division of Vascular Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Daniela Kandioler
- Division of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Stephanie Strobl
- Division of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Georg A Böhmig
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Thomas Soliman
- Division of Transplantation, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Gabriela A Berlakovich
- Division of Transplantation, Department of Surgery, Medical University of Vienna, Vienna, Austria
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23
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Heer MK, Clark D, Trevillian PR, Sprott P, Palazzi K, Hibberd AD. Functional significance and risk factors for lymphocele formation after renal transplantation. ANZ J Surg 2017; 88:597-602. [DOI: 10.1111/ans.14343] [Citation(s) in RCA: 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
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24
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Kim YM, Moon C, Goo DE, Park SB, Park JW. Lymphedema secondary to idiopathic occlusion of the subclavian and innominate veins after renal transplantation: A case report. Medicine (Baltimore) 2017; 96:e8942. [PMID: 29310388 PMCID: PMC5728789 DOI: 10.1097/md.0000000000008942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
RATIONALE Among the causes of swelling in the extremities of renal transplantation patients, secondary lymphedema caused by complete idiopathic obstruction of large veins is rare and may be difficult to diagnose and treat. PATIENT CONCERNS A 64-year-old man presented with severe edema and pain that occurred suddenly in the right arm. DIAGNOSES The patient was diagnosed as stage-2 secondary lymphedema caused by idiopathic occlusion of the subclavian and innominate veins. INTERVENTIONS Lymphoscintigraphy and ascending venography of the right arm confirmed the diagnosis. Intensive complete decongestive therapy for lymphedema was performed. OUTCOMES Following 2 weeks of active rehabilitation, the pain level and edema status were significantly improved. LESSONS When idiopathic swelling of the extremities occurs in renal transplant patients, secondary lymphedema caused by venous occlusion may be the cause. When direct intervention for the venous occlusion proves to be difficult, a conservative approach may be helpful.
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Affiliation(s)
- Yong Min Kim
- Department of Physical Medicine and Rehabilitation
| | | | - Dong Erk Goo
- Department of Radiology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Soo Bin Park
- Department of Radiology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
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25
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Salna M, Takayama H, Garan AR, Kurlansky P, Farr MA, Colombo PC, Imahiyerobo T, Morrissey N, Naka Y, Takeda K. Incidence and risk factors of groin lymphocele formation after venoarterial extracorporeal membrane oxygenation in cardiogenic shock patients. J Vasc Surg 2017; 67:542-548. [PMID: 28822659 DOI: 10.1016/j.jvs.2017.05.127] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 05/24/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Venous-arterial extracorporeal membrane oxygenation (VA-ECMO) is a well-established therapy for refractory cardiopulmonary failure. Femoral cannulation offers a quick and effective means of providing circulatory support but is not without complication. Inflammation or lymphatic disruption at the site of cannulation can cause the formation of lymphoceles, leading to the patient's discomfort and possibly necessitating intervention. The purpose of this study was to evaluate the incidence of in-hospital lymphocele formation in VA-ECMO patients and to identify predictors for their development. METHODS We conducted a single-center retrospective review of 192 patients who underwent femoral VA-ECMO insertion and subsequent decannulation from March 2007 to August 2016 for cardiogenic shock. Baseline demographics, risk factors, and cannulation strategies were examined. Groin lymphocele formation was assessed as the primary outcome. RESULTS Median age was 58 years (interquartile range, 48-67 years) with a median duration of support of 4 days (interquartile range, 2-6 days). Lymphocele formation was identified in 31 patients (16%). Patients who developed lymphoceles were more likely to have post-heart transplantation primary graft dysfunction (PGD) as an indication for ECMO support compared with those who did not (54.2% vs 8%; P < .001). ECMO duration was similar between groups, but lymphocele patients were more likely to have undergone femoral cutdown procedures (68% vs 42%; P = .010). Compared with those PGD patients who did not develop lymphoceles, PGD lymphocele patients had higher rates of diabetes mellitus preoperatively (62% vs 8%; P = .006). Thirteen (42%) patients required surgical incision and drainage, and 4 of these patients (31%) required repeated surgical intervention. CONCLUSIONS Lymphocele formation is relatively common after femoral VA-ECMO. There was a significantly higher incidence of lymphocele formation in diabetic patients requiring support for PGD after heart transplantation.
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Affiliation(s)
- Michael Salna
- Columbia University College of Physicians and Surgeons, New York, NY
| | - Hiroo Takayama
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY
| | - Arthur R Garan
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY
| | - Paul Kurlansky
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY
| | - Maryjane A Farr
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY
| | - Paolo C Colombo
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY
| | - Thomas Imahiyerobo
- Division of Plastic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY
| | - Nicholas Morrissey
- Division of Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York, NY
| | - Yoshifumi Naka
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY
| | - Koji Takeda
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY.
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26
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Mihaljevic AL, Heger P, Abbasi Dezfouli S, Golriz M, Mehrabi A. Prophylaxis of lymphocele formation after kidney transplantation via peritoneal fenestration: a systematic review. Transpl Int 2017; 30:543-555. [DOI: 10.1111/tri.12952] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Revised: 12/19/2016] [Accepted: 03/07/2017] [Indexed: 11/30/2022]
Affiliation(s)
- André L. Mihaljevic
- Department of General, Visceral and Transplantation Surgery; University Hospital Heidelberg; Heidelberg Germany
| | - Patrick Heger
- Department of General, Visceral and Transplantation Surgery; University Hospital Heidelberg; Heidelberg Germany
| | - Sepehr Abbasi Dezfouli
- Department of General, Visceral and Transplantation Surgery; University Hospital Heidelberg; Heidelberg Germany
| | - Mohammad Golriz
- Department of General, Visceral and Transplantation Surgery; University Hospital Heidelberg; Heidelberg Germany
| | - Arianeb Mehrabi
- Department of General, Visceral and Transplantation Surgery; University Hospital Heidelberg; Heidelberg Germany
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27
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Prevention and management of lymphocele formation following kidney transplantation. Transplant Rev (Orlando) 2017; 31:100-105. [DOI: 10.1016/j.trre.2016.11.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 11/09/2016] [Indexed: 11/19/2022]
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28
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Habermehl D, Habl G, Eckstein HH, Meisner F, Combs SE. [Radiotherapeutic management of lymphatic fistulas : An effective but disregarded therapy option]. Chirurg 2017; 88:311-316. [PMID: 28083600 DOI: 10.1007/s00104-016-0352-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Lymphatic fistulas and lymphoceles are known complications after vascular surgery of the groin and after extended surgical interventions in the pelvic region. Unfortunately, conservative standard therapies are not always successful. OBJECTIVES Evaluation of the therapeutic efficacy and related side effects of percutaneous low-dose irradiation in patients with lymphorrhea and definition of its importance. MATERIAL AND METHODS Current presentation of previously published case series, reviews and guidelines. RESULTS The use of low-dose irradiation therapy with single doses of 0.3-0.5 Gy leads to a cessation of the lymphatic flow in a high percentage of patients when standard therapies do not show a sufficient effect. With cessation of lymphorrhea irradiation should be terminated. Acute side effects have not been reported and the risk of tumor induction is almost negligible. CONCLUSION Low-dose irradiation is an effective and very well-tolerated therapeutic alternative in the treatment of lymphatic fistulas and lymphorrhea when conservative therapies are unsuccessful.
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Affiliation(s)
- D Habermehl
- Klinik für RadioOnkologie und Strahlentherapie, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81675, München, Deutschland. .,Institut für Innovative Radiotherapie (IRT), Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764, Oberschleißheim, Deutschland.
| | - G Habl
- Klinik für RadioOnkologie und Strahlentherapie, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81675, München, Deutschland
| | - H-H Eckstein
- Klinik und Poliklinik für Vaskuläre und Endovaskuläre Chirurgie, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81675, München, Deutschland
| | - F Meisner
- Klinik und Poliklinik für Vaskuläre und Endovaskuläre Chirurgie, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81675, München, Deutschland
| | - S E Combs
- Klinik für RadioOnkologie und Strahlentherapie, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81675, München, Deutschland.,Institut für Innovative Radiotherapie (IRT), Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764, Oberschleißheim, Deutschland
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29
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Massive Ascites in a Renal Transplant Patient after Laparoscopic Fenestration of a Lymphocele. Case Rep Transplant 2016; 2016:7491627. [PMID: 27891288 PMCID: PMC5116527 DOI: 10.1155/2016/7491627] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 10/19/2016] [Indexed: 11/17/2022] Open
Abstract
Retroperitoneal lymphocele is a common complication of renal transplantation. Here, we report the case of a 67-year-old woman with massive ascites after fenestration surgery for a lymphocele that developed following renal transplantation. She had been on continuous ambulatory peritoneal dialysis for 9 years. Living donor renal transplantation was performed and an intrapelvic lymphocele subsequently developed. The lymphocele did not resolve after aspiration therapy; therefore, laparoscopic fenestration was performed. Although the lymphocele disappeared, massive ascites appeared in its stead. Half a year later, the ascites was surgically punctured, which then gradually resolved and disappeared 6 weeks later. Aspiration therapy should be considered in patients on long-term peritoneal dialysis, although laparoscopic fenestration is safe and effective.
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30
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Complications chirurgicales de la transplantation rénale. Prog Urol 2016; 26:1066-1082. [DOI: 10.1016/j.purol.2016.09.052] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 08/29/2016] [Accepted: 09/01/2016] [Indexed: 12/13/2022]
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31
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Jun H, Hwang SH, Lim S, Kim MG, Jung CW. Evaluation of postoperative lymphocele according to amounts and symptoms by using 3-dimensional CT volumetry in kidney transplant recipients. Ann Surg Treat Res 2016; 91:133-8. [PMID: 27617254 PMCID: PMC5016603 DOI: 10.4174/astr.2016.91.3.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 05/23/2016] [Accepted: 05/30/2016] [Indexed: 12/05/2022] Open
Abstract
Purpose To analyze the risk factors for postoperative lymphocele, for predicting and preventing complications. Methods We evaluated 92 kidney transplant recipients with multidetector CT (MDCT) at 1-month posttransplantation. From admission and 1-month postoperative records, data including diabetes, dialysis type, immunosuppressant use, steroid pulse therapy, and transplantation side were collected. Lymphocele volume was measured with 3-dimensional reconstructed, nonenhanced MDCT at one month postoperatively. The correlations between risk factors and lymphocele volume and between risk factors and symptomatic lymphocele (SyL) were analyzed. The cutoff was calculated by using the receiver operating characteristic (ROC) curve for SyL volume. Results Among 92 recipients, the mean volume was 44.53 ± 176.43 cm3 and 12 had SyL. Univariable analysis between risk factors and lymphocele volume indicated that donor age, retransplantation, and inferiorly located lymphocele were statistically significant. The ROC curve for SyL showed that 33.20 cm3 was the cutoff, with 83.3% sensitivity and 93.7% specificity. On univariable analysis between risk factors and SyL, steroid pulse, inferiorly located lymphocele, and >33.20 cm3 were statistically significant. Multivariable analysis indicated that steroid pulse, >33.20 cm3, and serum creatinine level at one month were significant factors. Conclusion Risk factors including donor age, retransplantation, steroid pulse therapy, and inferiorly located lymphocele are important predictors of large lymphoceles or SyL. In high-risk recipients, careful monitoring of renal function and early image surveillance such as CT or ultrasound are recommended. If the asymptomatic lymphocele is >33.20 cm3 or located inferiorly, early interventions can be considered while carefully observing the changes in symptoms.
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Affiliation(s)
- Heungman Jun
- Department of Surgery, Korea University Anam Hospital, Seoul, Korea
| | - Sung Ho Hwang
- Department of Radiology, Korea University Anam Hospital, Seoul, Korea
| | - Sungyoon Lim
- Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Myung Gyu Kim
- Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Cheol Woong Jung
- Department of Surgery, Korea University Anam Hospital, Seoul, Korea.; Department of Surgery, Korea University College of Medicine, Seoul, Korea
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32
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Fockens MM, Alberts VP, Bemelman FJ, van der Pant KAMI, Idu MM. Wound morbidity after kidney transplant. Prog Transplant 2015; 25:45-8. [PMID: 25758800 DOI: 10.7182/pit2015812] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
CONTEXT Wound morbidity is an important surgical complication after kidney transplant. OBJECTIVE To assess risk factors for postoperative wound complications and the impact of such complications on outcomes of kidney transplant. DESIGN AND PATIENTS Retrospectively, 108 consecutive kidney transplant patients between January 2010 and December 2010 were included in the analysis. Wound morbidity was defined as a surgical site infection or symptomatic lymphocele requiring intervention. Patient, donor, and surgical characteristics were reviewed. RESULTS Eight lymphoceles and 5 surgical site infections occurred in 12 patients. Risk factors for wound complications were recipient's age (P<.01), body mass index (P=.01), urinary tract infection (P=.01), and prolonged postoperative wound drainage (P=.047). Wound morbidity did not increase the incidence of delayed graft function, acute rejection, graft failure, or mortality. Obesity, recipient's age, urinary tract infection, and prolonged wound drainage are risk factors for wound-related complications. Graft and patient survival rates are comparable between patients with and without wound-related complications.
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Affiliation(s)
- M Matthijs Fockens
- Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands
| | - Victor P Alberts
- Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands
| | - Frederike J Bemelman
- Renal Transplant Unit, Department of Internal Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - Karlijn A M I van der Pant
- Renal Transplant Unit, Department of Internal Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - Mirza M Idu
- Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands
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33
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Ranghino A, Segoloni GP, Lasaponara F, Biancone L. Lymphatic disorders after renal transplantation: new insights for an old complication. Clin Kidney J 2015; 8:615-22. [PMID: 26413290 PMCID: PMC4581383 DOI: 10.1093/ckj/sfv064] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 06/29/2015] [Indexed: 12/29/2022] Open
Abstract
In renal transplanted patients, lymphoceles and lymphorrhea are well-known lymphatic complications. Surgical damage of the lymphatics of the graft during the procurement and of the lymphatic around the iliac vessels of the recipients has been associated with development of lymphatic complications. However, lymphatic complications may be related to medical factors such as diabetes, obesity, blood coagulation abnormalities, anticoagulation prophylaxis, high dose of diuretics, delay in graft function and immunosuppressive drugs. Consistently, immunosuppression regimens based on the use of mTOR inhibitors, especially in association with steroids and immediately after transplantation, has been associated with a high risk to develop lymphocele or lymphorrhea. In addition, several studies have demonstrated the association between rejection episodes and lymphatic complications. However, before the discovery of reliable markers of lymphatic vessels, the pathogenic mechanisms underlining the development of lymphatic complications during rejection and the influence of mTOR inhibitors remained not fully understood. The recent findings on the lymphatic systems of either native or transplanted kidneys together with the advances achieved on lymphangiogenesis shared some lights on the pathogenesis of lymphatic complications after renal transplantation. In this review, we describe the surgical and medical causes of lymphatic complications focusing on the rejection and immunosuppressive drugs as causes of lymphatic complications.
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Affiliation(s)
- Andrea Ranghino
- Renal Transplantation Center 'A. Vercellone', Division of Nephrology Dialysis and Transplantation, Department of Medical Sciences , Città della Salute e della Scienza Hospital and University of Torino , Torino , Italy
| | - Giuseppe Paolo Segoloni
- Renal Transplantation Center 'A. Vercellone', Division of Nephrology Dialysis and Transplantation, Department of Medical Sciences , Città della Salute e della Scienza Hospital and University of Torino , Torino , Italy
| | - Fedele Lasaponara
- Division of Urology , Città della Salute e della Scienza Hospital , Torino , Italy
| | - Luigi Biancone
- Renal Transplantation Center 'A. Vercellone', Division of Nephrology Dialysis and Transplantation, Department of Medical Sciences , Città della Salute e della Scienza Hospital and University of Torino , Torino , Italy
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Tefik T, Ciftci HS, Kocak T, Sanli O, Ander H, Ziylan O, Oktar T, Verep S, Caliskan Y, Turkmen A, Oguz FS, Nane I. Effect of Donor Nephrectomy Technique on Recipient Lymphatic Drainage. Transplant Proc 2015; 47:1282-6. [PMID: 26093698 DOI: 10.1016/j.transproceed.2015.04.079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM We sought to evaluate the postoperative recipient lymphatic drainage depending on open donor nephrectomy (ODN) or laparoscopic (LDN) techniques. METHOD Between March 2012 and August 2014, 58 patients underwent renal transplantation from living-related donors. Thirty donors underwent ODN (group 1), and 28 LDN (group 2). Operations were performed by the same surgeons. Both cranial and caudal drainage catheters for lymphatic leakage were placed preoperatively and all the recipients received tacrolimus, mycophenolate mofetil, and steroid as immunosuppressive regimen. None of the patients had coagulation abnormalities. RESULTS All grafts were functioning during the early postoperative period and diuresis was ensured. No difference was observed on early postoperative period regarding to acute rejection (P = .329) or infection (P = .546). No difference was seen concerning mycophenolate mofetil and mycophenolate sodium regimens among the 2 groups (P = .227). In groups 1 and 2, the cranial drainage catheters were not taken out until postoperative days 5.5 ± 2.5 (range, 0-11) and 6.4 ± 3.8 (range, 0-14) and the caudal catheters stayed in place until days 8.8 ± 3.5 (range, 1-16) and 9.9 ± 5.9 (range, 3-22), respectively. No difference was found when comparing the cranial (P = .308) and caudal (P = .426) drainage periods. However, during clinical acute rejection episodes the cranial drainage period was longer in group 1 (P = .003). Three patients developed lymphoceles, 1 requiring drainage, in group 2. CONCLUSIONS There seems to be no difference in recipient lymphatic drainage by donor nephrectomy technique. A laparoscopic procedure may be advantageous owing to shorter lymphatic drainage during clinical acute rejection episodes.
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Affiliation(s)
- T Tefik
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
| | - H S Ciftci
- Department of Medical Biology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - T Kocak
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - O Sanli
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - H Ander
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - O Ziylan
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - T Oktar
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - S Verep
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Y Caliskan
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - A Turkmen
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - F S Oguz
- Department of Medical Biology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - I Nane
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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The Use of Tenckhoff Catheters for Draining of Symptomatic Lymphoceles: A Review of Literature and Our Experience. Transplant Proc 2015; 47:384-7. [DOI: 10.1016/j.transproceed.2014.12.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 12/30/2014] [Indexed: 11/21/2022]
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36
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Giuliani S, Gamba P, Kiblawi R, Midrio P, Ghirardo G, Zanon GF. Lymphocele after pediatric kidney transplantation: incidence and risk factors. Pediatr Transplant 2014; 18:720-5. [PMID: 25163815 DOI: 10.1111/petr.12341] [Citation(s) in RCA: 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.
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Affiliation(s)
- Stefano Giuliani
- Department of Pediatric & Neonatal Surgery, St George's Healthcare NHS Trust and University, London, UK; Division of Pediatric Surgery, Department of 'Salute della Donna e del Bambino', University of Padova, Padova, Italy
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A case of continuous negative pressure wound therapy for abdominal infected lymphocele after kidney transplantation. Case Rep Transplant 2014; 2014:742161. [PMID: 25374744 PMCID: PMC4206933 DOI: 10.1155/2014/742161] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 09/23/2014] [Indexed: 11/18/2022] Open
Abstract
Lymphocele is a common complication after kidney transplantation. Although superinfection is a rare event, it generates a difficult management problem; generally, open surgical drainage is the preferred method of treatment but it may lead to complicated postoperative course and prolonged healing time. Negative pressure wound therapy showed promising outcomes in various surgical disciplines and settings. We present a case of an abdominal infected lymphocele after kidney transplantation managed with open surgery and negative pressure wound therapy.
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38
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Abstract
Ultrasonography is an excellent tool for evaluation of the renal transplant in the immediate postoperative period and for long-term follow-up. In this article, normal imaging findings and complications of renal transplantations are described. Disease processes are divided into vascular, perinephric, urologic and collecting system, and parenchymal abnormalities. Attention is paid to the time of occurrence of each complication, classic imaging findings, and potential pitfalls.
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Affiliation(s)
- Shuchi K Rodgers
- Department of Radiology, Sidney Kimmel Medical College at Thomas Jefferson University, Einstein Medical Center, 5501 Old York Road, Philadelphia, PA 19141, USA.
| | - Christopher P Sereni
- Department of Radiology, Sidney Kimmel Medical College at Thomas Jefferson University, Einstein Medical Center, 5501 Old York Road, Philadelphia, PA 19141, USA
| | - Mindy M Horrow
- Department of Radiology, Sidney Kimmel Medical College at Thomas Jefferson University, Einstein Medical Center, 5501 Old York Road, Philadelphia, PA 19141, USA
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Van Praet C, Decaestecker K, Fonteyne V, Ost P, De Visschere P, Verschuere S, Rottey S, Lumen N. Contemporary minimally-invasive extended pelvic lymph node dissection for prostate cancer before curative radiotherapy: Prospective standardized analysis of complications. Int J Urol 2014; 21:1138-43. [DOI: 10.1111/iju.12534] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 05/18/2014] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Valérie Fonteyne
- Department of Radiotherapy; Ghent University Hospital; Ghent Belgium
| | - Piet Ost
- Department of Radiotherapy; Ghent University Hospital; Ghent Belgium
| | | | | | - Sylvie Rottey
- Department of Medical Oncology; Ghent University Hospital; Ghent Belgium
| | - Nicolaas Lumen
- Department of Urology; Ghent University Hospital; Ghent Belgium
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40
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Asim M, Nauman A. Symptomatic lymphocele developing soon after acute renal allograft rejection: coincidental or causal connection? Clin Kidney J 2013; 6:643-5. [PMID: 26120459 PMCID: PMC4438373 DOI: 10.1093/ckj/sft125] [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: 06/20/2013] [Accepted: 09/17/2013] [Indexed: 11/13/2022] Open
Abstract
A renal transplant patient developed a lymphocele soon after an episode of acute rejection (AR). The lymphocele rapidly increased in size causing transplant ureteric and venous obstruction, leading to acute graft dysfunction and swelling of the ipsilateral leg. We appraise the complex relationship that exists between AR, lymphangiogenesis and lymphocele formation to determine whether a case for a causal connection between AR and development of lymphocele can be made in our patient.
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Affiliation(s)
- Muhammad Asim
- Weill Cornell Medical College , Doha , Qatar ; Department of Medicine , Hamad Medical Corporation , Doha , Qatar
| | - Awais Nauman
- Department of Medicine , Hamad Medical Corporation , Doha , Qatar
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41
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Abstract
Kidney transplantation can be associated with various complications that vary from vascular complications to urologic disorders to immunologic adverse effects. In evaluating the recipient with graft dysfunction, clinicians can choose among several imaging modalities, including ultrasonography, nuclear medicine studies, computed tomography, and magnetic resonance imaging. This review discusses the evaluation of the kidney transplant recipient using these imaging procedures, emphasizing the clinical diagnostic utility and role of each modality. A kidney biopsy is often required as a gold standard for diagnostic purposes. However, because of the inherent risks of a kidney biopsy, noninvasive imaging in diagnosing causes of graft dysfunction is a highly desired tool used and needed by the transplant community. Because the diagnostic accuracy varies depending on the time course and nature of the transplant-related complication, this review also addresses the advantages and limitations of each modality. The recent advances in kidney transplant imaging techniques and their clinical implications are also discussed.
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Affiliation(s)
- Asif Sharfuddin
- Division of Nephrology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
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Lee H, Joo D, Huh K, Kim M, Kim S, Kim Y, Lee W. Laparoscopic Fenestration Versus Percutaneous Catheter Drainage for Lymphocele Treatment After Kidney Transplantation. Transplant Proc 2013; 45:1667-70. [DOI: 10.1016/j.transproceed.2012.11.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2012] [Accepted: 11/20/2012] [Indexed: 11/30/2022]
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CEUS Retrograde Cystography Is Helpful in Percutaneous Drainage of Complex Posttransplant Lymphocele. Case Rep Urol 2012; 2012:919215. [PMID: 22606639 PMCID: PMC3350148 DOI: 10.1155/2012/919215] [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: 08/03/2011] [Accepted: 10/02/2011] [Indexed: 11/18/2022] Open
Abstract
After monolateral dual kidney transplantation, a 69 years old male patient developed symptomatic lymphocele with mild hydroureteronephrosis, impaired renal function, and right inferior limb oedema. A percutaneous ultrasound-guided drainage of the fluid collection was planned, but the complex mutual relations between the collection and the renal hilus did not allow to identify a suitable route for a safe drainage insertion during conventional ultrasound examination. A retrograde cystography using echographic contrast agent was, therefore, performed, and it clarified the position of both ureters and the renal vessels, permitting an harmless ultrasound-guided percutaneous lymphocele drainage. In conclusion contrast-enhanced ultrasound retrograde cystography may be helpful in percutaneous drainage of complex posttransplant lymphocele.
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44
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Abstract
Renal transplantation is nowadays accepted as the treatment of choice for patients with end-stage renal disease. However, despite progress in immunosuppression and surgical techniques, various complications still can occur. Complications vary from vascular disorders and urologic diseases to parenchymal and immunologically related complications. The clinician evaluating the recipient with graft dysfunction has the option of choosing among a variety of imaging modalities including ultrasonography, nuclear medicine, computed tomography, and magnetic resonance imaging to start or continue the diagnostic work-up. In this article, we discuss the evaluation of the kidney transplant recipient using these imaging procedures, emphasizing the clinical diagnostic utility and role of each modality.
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Affiliation(s)
- Asif Sharfuddin
- Division of Nephrology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
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Zagdoun E, Ficheux M, Lobbedez T, Chatelet V, Thuillier-Lecouf A, Bensadoun H, Ryckelynck JP, Hurault de Ligny B. Complicated Lymphoceles After Kidney Transplantation. Transplant Proc 2010; 42:4322-5. [DOI: 10.1016/j.transproceed.2010.09.127] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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46
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Friedersdorff F, Roller C, Baumunk D, Giessing M, Miller K, Weikert S, Fuller TF. [Incarcerated hernia after laparoscopic drainage of a lymphocele]. Urologe A 2010; 49:1169-71. [PMID: 20464365 DOI: 10.1007/s00120-010-2323-7] [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: 11/29/2022]
Abstract
Laparoscopic lymphocele drainage is considered the gold standard for the treatment of lymphoceles after kidney transplantation. We report on a female patient who developed a symptomatic posttransplant lymphocele. After laparoscopic lymphocele drainage the patient presented with acute pain in the left lower abdomen. A CT scan showed a hernia into the peritoneal window. This is a rare but potentially severe complication after intraperitoneal lymphocele drainage. CT imaging and swift reoperation with enlargement of the peritoneal window are critical to avoid serious complications. To avoid bowel incarceration, the peritoneal window should be as large as possible.
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Affiliation(s)
- F Friedersdorff
- Klinik für Urologie, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
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