Ann Surg Treat Res.  2021 Dec;101(6):368-373. 10.4174/astr.2021.101.6.368.

Retroperitoneal Viscum album extract instillation in patients with a large amount of drainage after kidney transplantation

• Park YJ
• Mok SK
• Kim JY
• Yun SS
• Park SC

• KMID: 2522936
• DOI: http://doi.org/10.4174/astr.2021.101.6.368

Abstract

Purpose
After kidney transplantation (KT), a large amount of drainage can delay postoperative recovery. Viscum album extract is an agent used in pleurodesis, and the purpose of this study was to evaluate the efficacy of this agent in reducing the amount of drainage after KT.
Methods
Medical records of patients with a large amount of drainage (≥ 100 mL/day) on postoperative day (POD) 7 after KT who had undergone V. album extract instillation through drainage tube (n = 115) or conservative management (n = 177) were retrospectively reviewed. The primary endpoint was a decrease in the amount of drainage on POD 14 from POD 7.
Results
A decrease in the amount of drainage on POD 14 from POD 7 was larger in the V. album extract instillation group than in the conservative management group (–228.3 ± 181.6 mL vs. –144.6 ± 202.0 mL, P < 0.001). Duration of hospitalization after operation was shorter in the V. album extract instillation group than in the conservative management group (15.9 ± 3.2 days vs. 18.1 ± 5.3 days, P < 0.001). In multivariate analysis, there was a statistically significant association of V. album extract instillation with lower risk of persistent large amount of drainage (≥ 100 mL/day on POD 14), with an odds ratio of 0.57 (95% confidence interval, 0.35–0.93; P = 0.026).
Conclusion
Retroperitoneal V. album extract instillation could be effective in reducing the amount of drainage and promoting postoperative recovery in patients with a large amount of drainage after KT.

Keyword

Drug instillation; Kidney transplantation; Sclerotherapy

Figure

• 

  Fig. 1 Adjusted associations of clinical characteristics with persistent large amount of drainage (≥100 mL per day on postoperative day 14). OR, odds ratio; CI, confidence interval; ATG, antithymocyte globulin; BMI, body mass index; DGF, delayed graft function.

Reference

1. Mehrabi A, Fonouni H, Wente M, Sadeghi M, Eisenbach C, Encke J, et al. Wound complications following kidney and liver transplantation. Clin Transplant. 2006; 20 Suppl 17:97–110. PMID: 17100709.

2. Sawhney R, D'Agostino HB, Zinck S, Rose SC, Kinney TB, Oglevie SB, et al. Treatment of postoperative lymphoceles with percutaneous drainage and alcohol sclerotherapy. J Vasc Interv Radiol. 1996; 7:241–245. PMID: 9007804.

3. Petrosillo N, Drapeau CM, Nicastri E, Martini L, Ippolito G, Moro ML, et al. Surgical site infections in Italian Hospitals: a prospective multicenter study. BMC Infect Dis. 2008; 8:34. PMID: 18328101.

4. Zomorrodi A, Buhluli A. Instillation of povidone iodine to treat lymphocele and leak of lymph after renal transplantation. Saudi J Kidney Dis Transpl. 2007; 18:621–624. PMID: 17951955.

5. Tasar M, Gulec B, Saglam M, Yavuz I, Bozlar U, Ugurel S. Posttransplant symptomatic lymphocele treatment with percutaneous drainage and ethanol sclerosis: long-term follow-up. Clin Imaging. 2005; 29:109–116. PMID: 15752966.

6. Silas AM, Forauer AR, Perrich KD, Gemery JM. Sclerosis of postoperative lymphoceles: avoidance of prolonged catheter drainage with use of a fibrin sealant. J Vasc Interv Radiol. 2006; 17(11 Pt 1):1791–1795. PMID: 17142709.

7. Evans M, Bryant S, Huntley AL, Feder G. Cancer patients' experiences of using mistletoe (Viscum album): a qualitative systematic review and synthesis. J Altern Complement Med. 2016; 22:134–144. PMID: 26684278.

8. Kim M, Hwang J. Direct intranodal lipiodol injection for management of lymphocele in kidney transplant recipient. Korean J Transplant. 2020; 34(Supple 1):S111.

9. Lee YG, Jung I, Koo DH, Kang DY, Oh TY, Oh S, et al. Efficacy and safety of Viscum album extract (Helixor-M) to treat malignant pleural effusion in patients with lung cancer. Support Care Cancer. 2019; 27:1945–1949. PMID: 30218188.

10. Atray NK, Moore F, Zaman F, Caldito G, Abreo K, Maley W, et al. Post transplant lymphocele: a single centre experience. Clin Transplant. 2004; 18 Suppl 12:46–49. PMID: 15217407.

11. Goel M, Fle chner SM, Zhou L, Mastroianni B, Savas K, Derweesh I, et al. The influence of various maintenance immunosuppressive drugs on lymphocele formation and treatment after kidney transplantation. J Urol. 2004; 171:1788–1792. PMID: 15076277.

12. Ulrich F, Niedzwiecki S, Fikatas P, Nebrig M, Schmidt SC, Kohler S, et al. Symptomatic lymphoceles after kidney transplantation - multivariate analysis of risk factors and outcome after laparoscopic fenestration. Clin Transplant. 2010; 24:273–280. PMID: 19719727.

13. Derouiche A, Mechri M, Ktari MM, Helal I, Ben Abdallah T, Chebil M. [Lymphoceles after renal transplantation: study of risk factors]. Prog Urol. 2010; 20:301–306. French. PMID: 20380993.

14. Khauli RB, Stoff JS, Lovewell T, Ghavamian R, Baker S. Post-transplant lymphoceles: a critical look into the risk factors, pathophysiology and management. J Urol. 1993; 150:22–26. PMID: 8510262.

15. Veeramani M, Mishra S, Kurien A, Ganpule A, Sabnis R, Desai M. Does rejection have a role in lymphocele formation post renal transplantation? A single centre experience. Indian J Urol. 2010; 26:193–195. PMID: 20877595.

16. Lucewicz A, Wong G, Lam VW, Hawthorne WJ, Allen R, Craig JC, et al. Management of primary symptomatic lymphocele after kidney transplantation: a systematic review. Transplantation. 2011; 92:663–673. PMID: 21849931.

17. Derweesh IH, Ismail HR, Goldfarb DA, Araki M, Zhou L, Modlin C, et al. Intraoperative placing of drains decreases the incidence of lymphocele and deep vein thrombosis after renal transplantation. BJU Int. 2008; 101:1415–1419. PMID: 18190623.

18. Peterson JM, Barbul A, Breslin RJ, Wasserkrug HL, Efron G. Significance of T-lymphocytes in wound healing. Surgery. 1987; 102:300–305. PMID: 3497461.

19. Benavides C, Mahmoud KH, Knight R, Barcenas C, Kahan BD, Van Buren CT. Rabbit antithymocyte globulin: a postoperative risk factor for sirolimus-treated renal transplant patients? Transplant Proc. 2005; 37:822–826. PMID: 15848544.

20. Kim MH, Jun KW, Hwang JK, Park SC, Yun SS, Moon IS, et al. Incidence and outcome of isolated distal deep vein thrombosis in kidney transplant recipients. Ann Surg Treat Res. 2020; 98:324–331. PMID: 32528912.

21. Park S, Kim M, Kim JE, Kim K, Park M, Kim YC, et al. Characteristics of kidney transplantation recipients over time in South Korea. Korean J Intern Med. 2020; 35:1457–1467. PMID: 32218102.

22. Risaliti A, Corno V, Donini A, Cautero N, Baccarani U, Pasqualucci A, et al. Laparoscopic treatment of symptomatic lymphoceles after kidney transplantation. Surg Endosc. 2000; 14:293–295. PMID: 10741452.

23. Kim JY, Wee YM, Choi MY, Jung HR, Choi JY, Kwon HW, et al. Urinary transglutaminase 2 as a potent biomarker to predict interstitial fibrosis and tubular atrophy of kidney allograft during early posttransplant period in deceased donor kidney transplantation. Ann Surg Treat Res. 2019; 97:27–35. PMID: 31297350.