Open Access

ARTICLE

Lymphoceles: impact on kidney transplant recipients, graft, and healthcare system

Emily Nguyen¹, Michelle Minkovich¹, Olusegun Famure¹, Yanhong Li¹, Anand Ghanekar^1,2, Markus Selzner^1,2,*, S. Joseph Kim^1,3,*, Jason Y. Lee^1,4

1 Ajmera Family Transplant Centre, University Health Network, Toronto, Ontario, Canada
2 Department of Surgery, Division of General Surgery, University Health Network, Toronto, Ontario, Canada
3 Department of Medicine, Division of Nephrology, University Health Network, Toronto, Ontario, Canada
4 Department of Surgery, Division of Urology, University Health Network, Toronto, Ontario, Canada
Address correspondence to Dr. Jason Lee, University Health Network, 585 University Avenue, 11-PMB-186, Toronto, ON M5G 2N2 Canada

Canadian Journal of Urology 2021, 28(5), 10848-10857.

Abstract

Introduction: Following kidney transplantation, lymphoceles can impact patient and graft outcomes, while resulting in significant hospital resource utilization. We aimed to characterize the incidence, risk factors, outcomes, and clinical management of lymphoceles among kidney transplant recipients and review impact on health system utilization at a high-volume center.
Materials and methods: We conducted a single-center, observational cohort study on adults transplanted between January 1, 2005 and December 31, 2017. Incidence, risk factors, and clinical outcomes were assessed using the Kaplan-Meier product-limit method, multivariable logistic regression model, and Cox proportional hazards model, respectively.
Results: Lymphoceles developed in 72 of 1881 patients (3.8%). Multivariate analysis demonstrated that a longer time on dialysis before transplant [HR 1.09 (95% CI: 1.02, 1.17)], laparoscopic donor nephrectomy [HR 2.31 (95% CI: 1.04, 5.12)], and depleting induction therapy [HR 0.39 (95% CI: 0.18, 0.87)] were significant risk factors for lymphocele development. Lymphoceles independently increased the likelihood of hospital readmission [HR 3.96 (95% CI: 2.99, 5.25)] but had no significant effect on the likelihood of graft failure or death with graft function. Of 72 cases, 44 received a radiological or surgical intervention. Fifteen of 44 lymphoceles required further intervention due to re-accumulation or complications.
Conclusion: Patients with longer dialysis times, kidneys from laparoscopic donor nephrectomy, and depleting induction therapy were associated with an increased risk for developing symptomatic lymphoceles. Our center’s treatment for symptomatic lymphoceles did not result in significant graft dysfunction, but significantly higher healthcare resource utilization was noted.

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