Occurrence of a lymphocele following renal transplantation

INTRODUCTION The incidence of lymphoceles - lymphatic collections around a transplanted kidney - can be as high as 20%. We aimed to review the presentation, treatment and outcome of patients with lymphoceles. METHODS We reviewed a prospective database of 154 patients who underwent renal transplantation at our hospital from January 2005 to November 2008. RESULTS The mean age of the patients in our cohort was 46 (range 34-58) years. The incidence of lymphoceles in our series was 5.8% (n = 9). The median onset was 19 (range 6-28) days post-transplantation, while the median size of the lymphoceles was 5 (range 1.5-8) cm. Lymphoceles were most commonly found at the lower pole of the transplanted kidney. Eight patients with lymphoceles had received cadaveric transplants. While a majority of these patients did not have hydronephrosis on presentation, four had markedly elevated creatinine. Of the nine patients with lymphoceles, six were on macrolides (tacrolimus, sirolimus or everolimus), two were successfully managed conservatively, three were managed percutaneously and four required surgical drainage via either laparoscopic marsupialisation (n = 1) or open drainage (n = 3). There was no graft loss. CONCLUSION It remains unknown whether the choice of immunosuppressants increases the risk of lymphocele formation. Intervention is necessary in the case of impaired drainage of the pelvicalyceal system in these patients. Minimally invasive intervention, while effective in treating lymphoceles, does not provide definitive treatment. Surgical intervention should be considered early for the treatment of post-transplantation patients with lymphoceles, so as to shorten hospital stay and prevent further complications.