Complications and outcomes of post-transplant lymphocele management: a 30-year retrospective analysis

Current guidelines recommend percutaneous drainage as the first-line approach for the management of symptomatic lymphoceles following renal transplantation, with surgical fenestration reserved for refractory or recurrent cases. This study evaluates the effectiveness and safety of these therapeutic strategies in renal transplant recipients.

A retrospective analysis of 109 renal transplant recipients with symptomatic lymphoceles treated between 1993 and 2023 at a single public center was conducted. Recipients were followed from lymphocele diagnosis through treatment to resolution.

Percutaneous drainage was performed as the initial treatment in 101 recipients, while 8 underwent primary fenestration. Among patients treated with drainage, 43.5% developed infections, with infection risk increasing with catheter placement duration: odds ratio (OR) 2.57 (p = 0.28) at 2 weeks, 15.0 (p = 0.003) at 4 weeks, and 20.2 (p = 0.002) at 6 weeks. Resolution with drainage alone occurred in 54.8% of cases after a median of 39 days. The remaining patients required fenestration as a second-line treatment. No significant difference was observed in the total duration of hospital stay between the two methods.

Prolonged percutaneous drainage for post-transplant lymphoceles is associated with high infection rates and limited efficacy, warranting its use primarily for renal function stabilization or diagnostic purposes. Further studies are necessary to investigate alternative management strategies that may improve outcomes and reduce complications in recipients with symptomatic lymphoceles following renal transplantation.