Ann Surg Treat Res.  2016 Sep;91(3):133-138. 10.4174/astr.2016.91.3.133.

Evaluation of postoperative lymphocele according to amounts and symptoms by using 3-dimensional CT volumetry in kidney transplant recipients

• Jun H
• Hwang SH
• Lim S
• Kim MG
• Jung CW

• KMID: 2350540
• DOI: http://doi.org/10.4174/astr.2016.91.3.133

Abstract

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 cm³ 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 cm³ 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 cm³ were statistically significant. Multivariable analysis indicated that steroid pulse, >33.20 cm³, 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 cm³ or located inferiorly, early interventions can be considered while carefully observing the changes in symptoms.

Keyword

Kidney transplantation; Lymphocele; Cone-beam computed tomography; Three-dimensional imaging

MeSH Terms

Cone-Beam Computed Tomography
Creatinine
Dialysis
Early Intervention (Education)
Humans
Imaging, Three-Dimensional
Kidney Transplantation
Kidney*
Lymphocele*
Risk Factors
ROC Curve
Sensitivity and Specificity
Tissue Donors
Transplant Recipients*
Ultrasonography
Creatinine

Figure

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  Fig. 1 An example multidetector CT image of a postoperative lymphocele in a kidney transplant recipient. (A) Axial image (white arrow). (B) Three-dimensional reconstruction and automatic volume assessment.

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  Fig. 2 Receiver operating characteristic curve and cutoff lymphocele volume for a symptomatic lymphocele. AUC, area under the curve.

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