Lymphoceles following renal transplantation

Lymphoceles (lymphocysts) are abnormal collections of lymphatic fluid that can occur following surgery:

• lymphoceles can be visualized by ultrasound as a low echogenicity collection which may have thickened septa and internal debris
• lymphoceles following renal transplantation
  • incidence of lymphoceles varies from 0.6 to 16% of the time after kidney transplantation
    • majority of lymphoceles remain unrecognized when of small dimensions
    • lymphatic collections of larger dimension or located close to the ureter may become clinically manifest, usually between 18 and 180 days after transplantation
  • possible clinical manifestations of lymphoceles include
    • ipsilateral edema, deep venous thrombosis, bladder displacement, or obstruction of the ureter resulting in transplant malfunction, requiring drainage
  • management of symptomatic lymphoceles is unclear (1)
    • simple needle aspiration or percutaneous external drainage with or without injection of sclerosing solutions are a less invasive alternative to the surgical approach - however these techniques have high recurrence and complication rates (1,2)
    • open or laparoscopic intraperitoneal marsupialization of the lymphatic collection are other treatment options
      • however these require a hospital stay, general anesthesia, and sometimes extensive surgical dissection
    • a newer technique for the treatment of symptomatic lymphocele is via percutaneous intraperitoneal catheter placement has been reported with good results (1,2)
      • the use of "..outpatient surgical approach using ultrasound-guided intraperitoneal drainage with a Tenckhoff catheter appears to be a simple, effective, and safe method for treating unilobular recurrent symptomatic lymphocele after renal transplantation.." (1)

Reference:

• (1) Adani GL et alreatment of recurrent symptomatic lymphocele after kidney transplantation with intraperitoneal tenckhoff catheter.Urology. 2007 Oct;70(4):659-61.
• (2) Adani GL et al. Intraperitoneal Tenckhoff catheter for the treatment of recurrent lymphoceles after kidney transplantation: our early experience.Transplant Proc. 2007 Jul-Aug;39(6):1851-2