Korean J Transplant.  2023 Nov;37(Suppl 1):S97. 10.4285/ATW2023.F-6808.

The usefulness of lymphangiography in the lymphocele after renal transplantation

• Cho HJ
• Moon J
• Kim M
• Ban TH
• Choi BS
• Jeon C
• Hwang JK
• Kim J

• KMID: 2551684
• DOI: http://doi.org/10.4285/ATW2023.F-6808

Abstract

Background
After kidney transplantation, lymphatic leakage is a relatively common complication. Lymphangiography is used for diagnostic purposes, and various therapeutic effects have also been reported in these cases. Therefore, in this study, we aim to investigate their therapeutic effects.
Methods
Between September 2020 and April 2023, lymphangiography for lymphatic leakage was performed in five patients (two male, three female; age range 62 to 67) after renal transplantation. Lymphorrhea is defined as the continuous measurement of 100 mL or more of lymphatic fluid per day after the removal of the urinary catheter, around postoperative day 7, once urinary leakage has been ruled out based on blood urea nitrogen and creatinine levels. We conducted intranodal method lymphangiog-raphy in these patients, using a 25-gauge needle to inject lipiodol. Subsequently, we observed changes in the drainage volume.
Results
The amount of drainage before lymphangiography was 369.5 to 617 mL per day. Intranodal lymphangiography was technically successful in all cases. When examining the ratio of drainage volume before and after the procedure, we observed a maximum decrease of up to 98.3% and an average reduction of approximately 63.3%. Among the five cases, in one case, the immediate postprocedure reduction rate was only 10.3%. However, after reattempting the procedure 2 days later, we observed a reduction of 75.9%. In another case, the initial attempt resulted in a reduction of 47.9%. However, even after a period of ap-proximately 2 weeks, there was no further decrease in drainage volume. Subsequently, we reattempted the procedure, and it led to an additional reduction of 37.2%. Eventually, the drainage volume decreased to 165 mL per day, allowing us to conclude the drain placement successfully.
Conclusions
Although intranodal lymphangiography is originally a diagnostic tool, it has been proven to be a safe and effective method when used for the therapeutic management of lymphorrhea after kidney transplantation.