A Mehrabi1, Y Kulu1, M Sabagh1, E Khajeh1, S Mohammadi1, O Ghamarnejad1, M Golriz1, C Morath2, W O Bechstein3, G A Berlakovich4, N Demartines5, M Duran6, L Fischer7, L Gürke8, J Klempnauer9, A Königsrainer10, H Lang11, U P Neumann12, A Pascher13, A Paul14, P Pisarski15, J Pratschke16, S Schneeberger17, U Settmacher18, R Viebahn19, M Wirth20, B Wullich21, M Zeier2, M W Büchler1. 1. Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany. 2. Division of Nephrology, Heidelberg University Hospital, Heidelberg, Germany. 3. Department of General and Visceral Surgery, Frankfurt University Hospital, Goethe University, Frankfurt am Main, Germany. 4. Division of Transplantation, Department of Surgery, Vienna Medical University, Vienna, Austria. 5. Department of Visceral Surgery, CHUV University Hospital, Lausanne, Switzerland. 6. Department of Vascular and Endovascular Surgery, Düsseldorf University Hospital, Heinrich-Heine-University, Düsseldorf, Germany. 7. Department of Visceral and Transplantation Surgery, Hamburg-Eppendorf University Hospital, Hamburg, Germany. 8. Department of Vascular and Transplantation Surgery, Basel University Hospital, Basel, Switzerland. 9. Department of General, Visceral, and Transplantation Surgery, Hannover Medical University, Hannover, Germany. 10. Department of General, Visceral and Transplantation Surgery, Eberhard-Karls-University Hospital, Tübingen, Germany. 11. Department of General, Visceral and Transplantation Surgery, Johannes Gutenberg Medical University, Mainz, Germany. 12. Department of General, Visceral and Transplantation Surgery, RWTH University Hospital, Aachen, Germany. 13. Department of General, Visceral and Transplantation Surgery, Münster University Hospital, Münster, Germany. 14. Department of General, Visceral and Transplantation Surgery, Essen University Hospital, Essen, Germany. 15. Department of General, Visceral and Surgery, Freiburg University Hospital, Freiburg, Germany. 16. Department of Surgery, Charité University Hospital, Berlin, Germany. 17. Department of Visceral, Transplantation and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria. 18. Department of General, Visceral and Vascular Surgery, Jena University Hospital, Jena, Germany. 19. Department of Surgery, Knappschaftskrankenhaus University Hospital of Bochum, Ruhr University of Bochum, Bochum, Germany. 20. Department of Urology, Carl Gustav Carus University Hospital, Dresden, Germany. 21. Department of Urology and Pediatric Urology, University Hospital Erlangen, Erlangen, Germany.
Abstract
BACKGROUND: The incidence of lymphatic complications after kidney transplantation varies considerably in the literature. This is partly because a universally accepted definition has not been established. This study aimed to propose an acceptable definition and severity grading system for lymphatic complications based on their management strategy. METHODS: Relevant literature published in MEDLINE and Web of Science was searched systematically. A consensus for definition and a severity grading was then sought between 20 high-volume transplant centres. RESULTS: Lymphorrhoea/lymphocele was defined in 32 of 87 included studies. Sixty-three articles explained how lymphatic complications were managed, but none graded their severity. The proposed definition of lymphorrhoea was leakage of more than 50 ml fluid (not urine, blood or pus) per day from the drain, or the drain site after removal of the drain, for more than 1 week after kidney transplantation. The proposed definition of lymphocele was a fluid collection of any size near to the transplanted kidney, after urinoma, haematoma and abscess have been excluded. Grade A lymphatic complications have a minor and/or non-invasive impact on the clinical management of the patient; grade B complications require non-surgical intervention; and grade C complications require invasive surgical intervention. CONCLUSION: A clear definition and severity grading for lymphatic complications after kidney transplantation was agreed. The proposed definitions should allow better comparisons between studies.
BACKGROUND: The incidence of lymphatic complications after kidney transplantation varies considerably in the literature. This is partly because a universally accepted definition has not been established. This study aimed to propose an acceptable definition and severity grading system for lymphatic complications based on their management strategy. METHODS: Relevant literature published in MEDLINE and Web of Science was searched systematically. A consensus for definition and a severity grading was then sought between 20 high-volume transplant centres. RESULTS: Lymphorrhoea/lymphocele was defined in 32 of 87 included studies. Sixty-three articles explained how lymphatic complications were managed, but none graded their severity. The proposed definition of lymphorrhoea was leakage of more than 50 ml fluid (not urine, blood or pus) per day from the drain, or the drain site after removal of the drain, for more than 1 week after kidney transplantation. The proposed definition of lymphocele was a fluid collection of any size near to the transplanted kidney, after urinoma, haematoma and abscess have been excluded. Grade A lymphatic complications have a minor and/or non-invasive impact on the clinical management of the patient; grade B complications require non-surgical intervention; and grade C complications require invasive surgical intervention. CONCLUSION: A clear definition and severity grading for lymphatic complications after kidney transplantation was agreed. The proposed definitions should allow better comparisons between studies.
Authors: Mohammad Golriz; Mohammadsadegh Sabagh; Golnaz Emami; Sara Mohammadi; Ali Ramouz; Elias Khajeh; Omid Ghamarnejad; Christian Morath; Markus Mieth; Yakup Kulu; Martin Zeier; Arianeb Mehrabi Journal: J Clin Med Date: 2021-11-30 Impact factor: 4.241