Risk Factors of Lymphocele following Living Donor Renal Transplantation

Abstract

In this study, we investigated the risk factors for lymphocele occurrence following living donor kidney transplantation.【Methods】We retrospectively reviewed 68 cases of living-donor kidney transplantation performed at our institution between January 2002 and July 2024. Lymphocele was defined as peri-transplant fluid collection identified by ultrasound or computed tomography. The relationships between lymphocele incidence and patient background, surgical techniques, and perioperative outcomes were analyzed. Surgical periods were categorized as early, middle, late, or recent, according to surgeon transitions. Interventions included drainage, lymphangiography, and fenestration.【Results】Lymphoceles occurred in 16 patients (23.5％), with incidence rates of 12.5％, 18.8％, 12.5％, and 45％ in the early, middle, late, and recent periods, respectively. The incidence was significantly higher in cases managed with sealing alone compared to those in which ligation was performed during surgery (6/42, 14.3％ vs. 10/26, 38.5％ ; p＝0.038). Early everolimus initiation within 2 weeks (p＝0.08), prolonged cold ischemia time (p＝0.053), and the surgical period (p＝0.08) displayed non-significant trends toward higher incidence. Of the 16 patients, eight remained under observation without intervention; of these, six patients showed spontaneous resolution and two remained asymptomatic. The remaining eight patients underwent interventions, such as drainage (n＝6), lymphangiography (n＝1), and fenestration (n＝1). Of these, seven cases showed improvement, while one patient who underwent lymphangiography remained under observation due to prioritization of another condition. All three cases requiring drainage involved preparation using the sealing method only.【Conclusion】Omission of ligation during preparation was associated with an increased lymphocele incidence.