Prevention of Lymphocele Formation Following Renal Allotransplantation

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Abstract
Lymphocele formation is a recognized complication of renal allotransplantation that can jeopardize the graft and cause major morbidity for the allograft recipient. Previously, emphasis was placed on treatment as opposed to prevention. An attempt was made to prevent lymphocele formation by adopting 2 techniques in performing the renal transplantation. The area of dissection was limited in the recipient to that necessary to obtain vessel control of the segment of iliac vessel that was to be used for the vascular anastomosis (to decrease the number of lymphatics divided or destroyed). Lymphostasis was practiced as meticulously as hemostasis. No attempt was made to ligate lymphatics in the hilus of the kidney. Using these techniques 198 consecutive renal allografts were performed without the development of an identifiable lymphocele. The limitation of the area of vessel dissection did not increase either the rate of major vascular complications (2%) or the development of major pulmonary embolism (0.5%) after transplantation. Extensive dissection of the iliac vessels is not necessary to prevent major vascular complications or pulmonary emboli after renal transplantation; careful lymphostasis in the allograft recipient will prevent the development of a lymphocele. Apparently, the lymph fluid in a lymphocele is derived primarily from the allograft recipient, not from the allograft.