Management of lymphoceles after kidney transplantation is highly variable. The aim of this study was to evaluate and compare the different approaches of lymphocele management among kidney transplant recipients.
MEDLINE and EMBASE were systematically searched for case studies published between 1954 and 2010. Inclusion criteria were symptomatic lymphoceles developing in recipients of deceased or living donor kidneys with specified intervention and outcome. Primary outcome was the rate of recurrence. Secondary outcomes were the rate of conversion from laparoscopic to open surgery, hospital stay, and complication rates.
Fifty-two retrospective case series with 1113 cases of primary lymphocele were selected for review. No randomized controlled trials or prospective cohort studies were located. Primary treatment modalities included were as follows: aspiration (n=218), sclerotherapy (n=155), drainage (n=219), laparoscopic surgery (n=333), and open surgery (n=188). Of the 218 cases of lymphocele managed with aspiration alone, 141 recurred with a recurrence rate of 59% (95% confidence interval [CI]: 52–67). Among those who received laparoscopic and open surgery, the recurrence rates were 8% (95% CI: 6–12) and 16% (95% CI: 10–24), respectively. The conversion rate from laparoscopic to open surgery was 12% (95% CI: 8–16).
Laparoscopic fenestration of a symptomatic lymphocele is associated with the lowest risk of lymphocele recurrence. However, the evidence base to support a recommendation for laparoscopic surgery as first line treatment is weak and highlights the need for a multicenter prospective cohort study to examine the benefits of incorporating initial simple aspiration into the management of lymphocele after kidney transplantation.
1 Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, Australia.
2 School of Public Health, Sydney Medical School, The University of Sydney, Sydney, Australia.
3 Department of Surgery, Westmead Hospital, Sydney, Australia.
4 Transplantation Services, Royal Prince Alfred Hospital, Sydney, Australia.
5 Cochrane Renal Group, Centre for Kidney Research, Westmead Children's Hospital, Sydney, Australia.
G.W. is the recipient of the Don and Lorraine Jacquot Fellowship, and is also partially funded by the Screening and Diagnostic Test Evaluation Program (STEP) and the Health Economics Research, Modeling and Evaluation in Sydney (HERMES) Capacity Building Grant.
All other authors declare no funding or conflicts of interest.
6 Address correspondence to: Dr. Germaine Wong, M.P.H., Ph.D., F.R.A.N.Z.C.P., Centre for Kidney Research, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145, Australia.
A.L. participated in research design, the writing of the manuscript, the performance of the research, and in data analysis. G.W. participated in research design, the writing of the manuscript, the performance of the research, and in data analysis. V.L. participated in research design, the writing of the manuscript, the performance of the research, and in data analysis. W.H. participated in research design. R.A. participated in research design and the writing of the manuscript. J.C. participated in research design, the writing of the manuscript, and in data analysis. H.P. participated in research design and the writing of the manuscript.
Supplemental digital content (SDC) is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (www.transplantjournal.com).
Received 4 May 2011. Revision requested 16 June 2011.
Accepted 20 June 2011.