Long-term patient follow-up after post-kidney transplant symptomatic lymphocele therapy

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Authors: J. Pacovsky ^1,2; M. Matysková Kubišová ^2,3; P. Navrátil ^1,2; I. Novák ^1,2; I. Guňka ^2,4; M. Broďák ¹
Authors place of work: Urologická klinika FN a LF UK Hradec Králové ¹; Mezioborové transplantační centrum FN a LF UK Hradec Králové ²; Hemodialyzační středisko FN a LF UK Hradec Králové ³; Chirurgická klinika FN a LF UK Hradec Králové ⁴
Published in the journal: Rozhl. Chir., 2019, roč. 98, č. 8, s. 321-325.
Category: Původní práce
doi: https://doi.org/10.33699/PIS.2019.98.8.321–325

Summary

Introduction: Symptomatic lymphocele could impair the function of a graft kidney. The aim of our research was to conduct a five-year follow-up after symptomatic lymphocele therapy.

Methods: Overall 50 patients undergoing the therapy of symptomatic lymphocele were enrolled in the study cohort. Demographic data, renal failure causes, indication of therapy and lymphocele management were retrospectively evaluated. Laboratory tests were done to evaluate serum creatinine, total plasma protein and albumin levels. Survival rates of the patients and of the grafts were analysed using Kaplan-Meier curves.

Results: The mean age of the 50 patients (44% females, 56% males) was 51.5±11.8 years, and the time between kidney transplantation and symptomatic lymphocele diagnosis was 12.8±21.5 months. Average lymphocele diameter was 71±35 mm. Causes of the native kidney failure were: glomerulonephritis (34%), tubulointerstitial nephritis (30%), polycystosis (24%), diabetic nephropathy (10%) and nephrosclerosis (2%). The therapy indications were: serum creatinine elevation (44%), graft hydronephrosis (38%), serum creatinine elevation associated with hydronephrosis (8%), infection associated with hydronephrosis (6%) and infection (4%). The lymphocele was managed by: open surgical intraperitoneal drainage (40%), percutaneous aspiration (26%), percutaneous long-term drainage (18%) and laparoscopic intraperitoneal drainage (16%). Mean serum creatinine levels at the time of the therapy and 60 months later were 231 µmol/L and 172 µmol/L, respectively; total plasma protein levels were 59 g/L and 69 g/L, respectively; albumin plasma levels were 36 g/L and 43 g/L, respectively. The five-year patient survival rate was 86% and the graft survival rate was 66%.

Conclusion: Adequate management of symptomatic lymphocele stabilizes the graft function. If the post-transplant lymphocele is indicated for therapy, the therapy should be applied as soon as possible to prevent fibrous changes in the surrounding tissues. No patient death or graft loss had any direct relationship with lymphocele management.

Keywords:

lymphocele – indication – long-term results

Zdroje

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