Lymphocele after kidney transplantation: Incidence, associated factors and outcomes

The outcome of renal transplantation is influenced by the occurrence of various complications, including urological. One of the most frequently occurring complications is lymphocele with an incidence of 0.6% to 51%. In fact, Lymphocele represents a notable postoperative complication that can lead to acute dysfunction of the renal graft or compression of adjacent venous structures. Despite its clinical relevance, the risk factors associated with its development remain inconsistently reported in the literature.

To evaluate the incidence, identify potential risk factors, and assess the clinical outcomes related to post-transplant lymphocele formation.

We analyzed 86 consecutive renal transplant recipients from 2010 to 2019. All recipients had undergone protocol screening ultrasound scan at first week after surgery and 3 months post-transplant. We analyzed risk factors for lymphocele formation. Comparison between lymphocele and no-lymphocele groups was made with linear logistic regression analyses.

Among the 86 kidney transplant recipients, 15 patients (17.4%) developed a lymphocele, with a median onset of 30 days post-transplantation (range: 30-330 days). The condition was asymptomatic in the majority of cases (14 patients, 93%), while one patient (7%) presented with ipsilateral lower limb lymphedema, which led to the diagnosis. Therapeutic intervention was necessary in four cases. Sclerotherapy using a povidone-iodine solution was performed in three patients, while one patient underwent combined sclerotherapy and percutaneous drainage.Multivariate analysis identified two independent risk factors: Warm ischemia time exceeding 30 minutes [P = 0.011; odds ratio (OR) = 1.103; 95%CI: 1.023-1.109] and donor age over 50 years (P = 0.041; OR = 1.072; 95%CI: 1.023-1.146). Renal function at one year was comparable between patients who developed a lymphocele and those who did not.

Our findings suggest that improved surgical techniques and optimized immunosuppressive management could contribute to reducing the incidence of lymphocele and enhancing post-transplant renal outcomes.