C60 Lymphocele after kidney transplantation

The term lymphocele denotes a limited collection of serous liquid in the wound after kidney transplantation. Lymph flows into the operation wound from the damaged lymphatic vessels in the vicinity of the iliac veins of the recipient or from the lymphatic vessels in the hilum of the kidney damaged during its removal from a cadaveric or living donor. The family of lymphoceles includes also persisting lymph flow through a drain placed in the wound after kidney transplantation. Symptomatology of the lymphocele depends on its size and location. Small asymptomatic lymphoceles predominate that are found accidentally during a post-surgery follow-up of the patient. Large lymphoceles squeeze and compress the ureter of the transplanted kidney hereby impeding the drainage, which eventually impairs the function of the transplanted kidney. The pressure of the lymphocele on the venous drainage in the small pelvis of the recipient brings about an oedema of the ipsilateral lower limb or of the genitalia. Sovereign diagnostic methods include USG and CT. Resolution between an urinoma and lymphocele is based on biochemical examination of the content of the lymphocele. The treatment of lymphocele consists in percutaneous or laparoscopic drainage, or in open marsupialization of the lymphocele into the peritoneal cavity. Very rarely can one identify the vessel from which lymph is flowing out and to handle it surgically. Small asymptomatic lymphoceles do not require active treatment.

Between 2007 and 2009, 131 kidneys have been transplanted to 72 men and 59 women. 125 kidneys have been removed from cadaveric, 6 kidneys from living donors. In 17 patients (12.9%) we have found symptomatic lymphoceles. The lymphocele was observed more often in women (10/59 = 16.9%) than in men (7/72 = 9.7%) and was diagnosed on the average 12.4 days (from 7 to 20 days) after surgery. In 14 patients, the dominant symptom of the lymphocele was impaired function of the transplanted kidney with ureterohydronephrosis. In 3 patients the lymphocele caused oedema of the lower limb.

In 2 patients, lymphocele resorbed spontaneously. 9 lymphoceles were drained by a percutaneously inserted punction drain (in one case the ureter of the transplanted kidney was hereby injured). The six largest lymphocelas were marsupialized into the peritoneal cavity. Three operations were performed laparoscopically, three operations by open surgery.

Active treatment of the lymphocele consists of its drainage. In the treatment of largest lymphoceles, the open surgical approach proved to be good by lower midline laparotomy. In this way one can avoid the transplanted kidney while identifying the extent of the lymphocela and performing targeted marsupialization, possibly also inserting a lappet of the omentum into the cavity of the lymphocele. All lymphoceles have been treated successfully, not even one transplanted kidney has been lost.