Fluorescence lymphography in kidney transplantation (FLIKT-study)-real time intraoperative lymphography to avoid...

Lymphocele formation is a frequent complication after kidney transplantation, occurring in up to 26% of recipients. It results mainly from lymphatic injury during dissection of the iliac vessels and can impair graft function by compressing the renal graft, vascular structures, or ureter. Improved intraoperative visualization of lymphatic vessels may reduce this risk. Indocyanine green (ICG) fluorescence technology enables real-time lymphatic mapping. This study evaluated the feasibility and clinical utility of ICG fluorescence-guided lymphography during kidney transplantation.

In a prospective single-center study, ICG lymphography was performed in 21 consecutive living-donor kidney transplantations. Under ultrasound guidance, ICG was injected into the subcutaneous tissue of the ipsilateral femoral triangle one hour before surgery. Lymphatic structures were visualized intraoperatively using a handheld fluorescence imaging system (Spy-Phi, Stryker) at four procedural time points. Identified lymphatic vessels were preserved, and any visualized lymphatic leakage was clipped. Postoperative surveillance included weekly ultrasonography in the early postoperative phase and MRI at 6 months.

ICG injection enabled clear visualization of retroperitoneal lymphatic vessels in all 21 cases. Lymphatic structures were successfully preserved during dissection. In two cases, intraoperative lymphatic leakage was detected and controlled. Postoperative ultrasound showed no perirenal fluid collections in any patient. MRI performed in 15/21 patients at 6 months confirmed absence of lymphocele formation.

ICG-guided lymphography is a safe, feasible technique for intraoperative visualization of lymphatic vessels during kidney transplantation and may help prevent lymphocele formation.