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Treatment of Post-transplant Lymphocele in Children
Romy Gander1, Marino Asensio1, Gloria Fatou Royo1
1Pediatric Urology and Renal Transplant Unit, Department of Pediatric Surgery, Hospital Vall d'Hebron, Barcelona, Spain.
Insights
Post-transplant lymphoceles in pediatric kidney recipients are common. Percutaneous catheter drainage and transcatheter sclerotherapy offer safe and effective management, though they may prolong hospitalization.
Area of Science:
- Pediatric Nephrology
- Transplant Surgery
- Urology
Background:
- Post-transplant lymphoceles are known complications following pediatric kidney transplantation (KT).
- Current literature lacks a consensus on the optimal management strategy for pediatric post-transplant lymphoceles.
- This study reviews a single center's experience in managing these complications.
Purpose of the Study:
- To evaluate the management and outcomes of post-transplant lymphoceles in pediatric kidney transplant recipients.
- To assess the safety and efficacy of different treatment modalities.
- To contribute to the limited literature on this topic.
Main Methods:
- Retrospective review of a single institutional database.
- Inclusion criteria: pediatric KT recipients who developed lymphoceles between January 2000 and December 2015.
- Diagnostic procedures included ultrasound; treatments involved observation, percutaneous catheter drainage, and transcatheter sclerotherapy (TS).
Main Results:
- Lymphoceles occurred in 9 out of 176 (5.1%) pediatric KT recipients.
- Asymptomatic lymphoceles (n=3) resolved spontaneously. Symptomatic cases (n=6) were treated with drainage or TS.
- Transcatheter sclerotherapy (TS) with povidone-iodine was initially used, with some cases requiring alternative agents (polidocanol) or open drainage.
- No graft loss or recurrence was observed during a mean follow-up of 30.3 months.
Conclusions:
- There is no established gold-standard treatment for pediatric post-transplant lymphoceles.
- Percutaneous catheter drainage, with or without transcatheter sclerotherapy (TS), is a safe and effective approach.
- While effective, these interventions may increase hospitalization duration and morbidity.
Objective:
To review our single-center experience in managing posttransplant lymphoceles in pediatric kidney recipients. Lymphoceles are well-known complications after pediatric kidney transplantation (KT). However, there is no standard treatment for lymphoceles, and the literature lacks consensus on which is the most appropriate approach.
Materials And Methods:
We reviewed our retrospective institutional database for recipients of pediatric KT performed between January 2000 and December 2015 who developed lymphoceles.
Results:
Out of the 176 patients who underwent KT, lymphoceles occurred in 9 (5.1%) patients. The mean age of recipients in this group was 12.8 years (standard deviation [SD] 4.8) (r: 1-17) and the mean body weight was 43.1 kg (SD 18.8) (r: 9.5-69). Mean lymphocele onset was 32.2 days (SD 23.4) (r: 11-85) post transplantation. Six patients presented with increased serum creatinine from the baseline, whereas 3 patients remained asymptomatic. Ultrasound was the primary diagnostic procedure in all patients. Lymphoceles resolved spontaneously in asymptomatic patients (n = 3), and thus these patients were not further treated. All symptomatic patients (n = 6) were treated: 2 underwent percutaneous catheter drainage and 4 underwent transcatheter sclerotherapy (TS). The main sclerosing agent used was povidone-iodine. In 3 patients, TS with povidone-iodine failed, and they underwent additional procedures: 2 underwent TS with polidocanol and 1 underwent open drainage. There was no graft loss in any of the patients, and no recurrence was documented during a follow-up period of mean 30.3 months (SD 15.6) (r: 7-57).
Conclusion:
There is no gold-standard treatment for lymphoceles in children, and reports in the literature on the topic are scarce. Percutaneous catheter drainage with or without TS is safe and effective, although it can lengthen hospitalization and increase morbidity.
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