Lymphocele after renal transplant: Prevention and management

Lymphocele is a common postoperative complication following renal transplantation, with reported incidence ranging from 0.6% to 38%. Symptomatic lymphoceles, occurring in 5%-10% of recipients, may cause graft dysfunction through ureteric or vascular compression. This minireview provides a comprehensive synthesis of the epidemiology, pathophysiology, risk factors, prevention, diagnosis, and management of post-transplant lymphoceles. Prevention strategies include meticulous surgical ligation of lymphatics, prophylactic peritoneal fenestration, and delaying the use of mammalian target of rapamycin inhibitors in the early post-transplant period. Diagnosis is best achieved using ultrasound, with computed tomography or magnetic resonance imaging reserved for complex cases. Management follows a stepwise approach: Conservative observation for small asymptomatic collections, percutaneous drainage with or without sclerotherapy for symptomatic cases, and laparoscopic marsupialization for refractory or complicated lymphoceles. Novel techniques, including intraoperative lymphangiography and bioengineered sealants, represent promising future strategies for addressing these challenges. This minireview highlights the importance of integrating surgical refinement, tailored immunosuppression, and emerging technologies to optimize outcomes in renal transplant recipients.