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The estimation of post-transplant lymphocele origin using creatine kinase activity
Jaroslav Pacovsky1, Radomir Hyspler, Pavel Navratil
1Department of Urology-Regional Transplant Center, University Hospital and Charles University Medical School, Hradec Kralove, Czech Republic. japacovsky@post.cz
Introduction:
The aim of this research was to create a laboratory instrument for the estimation of post-transplant lymphocele origin. It is based on the enzymatic activity of creatine kinase (CK) in the lymphocele content.
Material And Methods:
A total of 120 lymph samples from different retroperitoneal regions were obtained from non-transplanted patients; equal numbers from the iliac region, renal cysts, and the subdiaphragmatic retroperitoneum. Activities of creatine kinase (CK) and gamma-glutamyl transpeptidase (GGT) were determined in all samples and statistically analyzed against their activity in serum from patients without surgery.
Results:
Activities of CK in the pelvis, retroperitoneum, renal cysts, and serum were 5.06, 0.83, 6.48 (P<0.001), 2.50, 0.73, 3.60 (P<0.001), 0.02, 0.01, 0.05 (P<0.001), and 0.66, 0.41, 0.79 microkat/l, respectively. Activities of GGT in the same lymph samples were 0.26, 0.16, 0.36 (P=0.048), 0.41, 0.25, 0.48 (non-significant), 0.11, 0.07, 1.17 (P=0.003) and 0.34, 0.24, 0.55 microkat/l, respectively. A graph was constructed relating CK activity to lymph origin.
Conclusion:
Significantly different CK enzyme activity was observed in different regions of the retroperitoneum. The presented graph is a simple instrument for the estimation of the lymphocele content origin. The method requires percutaneous aspiration of the lymphocele and evaluation of the CK and GGT activity in the sample. From the graph the estimated proportion of renal lymph in the lymphocele can be read directly. This instrument can provide better understanding of post-transplant lymphocele fluid source.