Purpose: To analyze the risk factors for postoperative lymphocele, for predicting and preventing complications.
Methods: We evaluated 92 kidney transplant recipients with multidetector CT (MDCT) at 1-month posttransplantation. From admission and 1-month postoperative records, data including diabetes, dialysis type, immunosuppressant use, steroid pulse therapy, and transplantation side were collected. Lymphocele volume was measured with 3-dimensional reconstructed, nonenhanced MDCT at one month postoperatively. The correlations between risk factors and lymphocele volume and between risk factors and symptomatic lymphocele (SyL) were analyzed. The cutoff was calculated by using the receiver operating characteristic (ROC) curve for SyL volume.
Results: Among 92 recipients, the mean volume was 44.53 ± 176.43 cm(3) and 12 had SyL. Univariable analysis between risk factors and lymphocele volume indicated that donor age, retransplantation, and inferiorly located lymphocele were statistically significant. The ROC curve for SyL showed that 33.20 cm(3) was the cutoff, with 83.3% sensitivity and 93.7% specificity. On univariable analysis between risk factors and SyL, steroid pulse, inferiorly located lymphocele, and >33.20 cm(3) were statistically significant. Multivariable analysis indicated that steroid pulse, >33.20 cm(3), and serum creatinine level at one month were significant factors.
Conclusion: Risk factors including donor age, retransplantation, steroid pulse therapy, and inferiorly located lymphocele are important predictors of large lymphoceles or SyL. In high-risk recipients, careful monitoring of renal function and early image surveillance such as CT or ultrasound are recommended. If the asymptomatic lymphocele is >33.20 cm(3) or located inferiorly, early interventions can be considered while carefully observing the changes in symptoms.
Keywords: Cone-beam computed tomography; Kidney transplantation; Lymphocele; Three-dimensional imaging.