Gander Romy, Asensio Marino, Royo Gloria Fatou, Molino Jose Andrés, Vilalta Ramón, Coma Ana, Perez Mercedes, Ariceta Gema
Pediatric Urology and Renal Transplant Unit, Department of Pediatric Surgery, Hospital Vall d'Hebron, Barcelona, Spain.
Pediatric Urology and Renal Transplant Unit, Department of Pediatric Surgery, Hospital Vall d'Hebron, Barcelona, Spain.
Urology. 2017 May;103:218-223. doi: 10.1016/j.urology.2016.12.039. Epub 2017 Jan 26.
To review our single-center experience in managing posttransplant lymphoceles in pediatric kidney recipients. Lymphoceles are well-known complications after pediatric kidney transplantation (KT). However, there is no standard treatment for lymphoceles, and the literature lacks consensus on which is the most appropriate approach.
We reviewed our retrospective institutional database for recipients of pediatric KT performed between January 2000 and December 2015 who developed lymphoceles.
Out of the 176 patients who underwent KT, lymphoceles occurred in 9 (5.1%) patients. The mean age of recipients in this group was 12.8 years (standard deviation [SD] 4.8) (r: 1-17) and the mean body weight was 43.1 kg (SD 18.8) (r: 9.5-69). Mean lymphocele onset was 32.2 days (SD 23.4) (r: 11-85) post transplantation. Six patients presented with increased serum creatinine from the baseline, whereas 3 patients remained asymptomatic. Ultrasound was the primary diagnostic procedure in all patients. Lymphoceles resolved spontaneously in asymptomatic patients (n = 3), and thus these patients were not further treated. All symptomatic patients (n = 6) were treated: 2 underwent percutaneous catheter drainage and 4 underwent transcatheter sclerotherapy (TS). The main sclerosing agent used was povidone-iodine. In 3 patients, TS with povidone-iodine failed, and they underwent additional procedures: 2 underwent TS with polidocanol and 1 underwent open drainage. There was no graft loss in any of the patients, and no recurrence was documented during a follow-up period of mean 30.3 months (SD 15.6) (r: 7-57).
There is no gold-standard treatment for lymphoceles in children, and reports in the literature on the topic are scarce. Percutaneous catheter drainage with or without TS is safe and effective, although it can lengthen hospitalization and increase morbidity.
回顾我们在处理小儿肾移植受者移植后淋巴囊肿方面的单中心经验。淋巴囊肿是小儿肾移植（KT）后众所周知的并发症。然而，对于淋巴囊肿尚无标准治疗方法，且文献中对于哪种方法最为合适也缺乏共识。
我们回顾了2000年1月至2015年12月期间在我院接受小儿KT且发生淋巴囊肿的受者的回顾性机构数据库。
在176例接受KT的患者中，9例（5.1%）发生了淋巴囊肿。该组受者的平均年龄为12.8岁（标准差[SD]4.8）（范围：1 - 17岁），平均体重为43.1 kg（SD 18.8）（范围：9.5 - 69 kg）。淋巴囊肿平均发病时间为移植后32.2天（SD 23.4）（范围：11 - 85天）。6例患者血清肌酐较基线水平升高，而3例患者无症状。超声是所有患者的主要诊断方法。无症状患者（n = 3）的淋巴囊肿自行消退，因此这些患者未进一步治疗。所有有症状的患者（n = 6）均接受了治疗：2例行经皮导管引流，4例行经导管硬化治疗（TS）。主要使用的硬化剂是聚维酮碘。3例患者使用聚维酮碘进行TS治疗失败，他们接受了额外的手术：2例行使用聚多卡醇的TS治疗，1例行开放引流。所有患者均未出现移植物丢失，在平均30.3个月（SD 15.6）（范围：7 - 57个月）的随访期内未记录到复发情况。
儿童淋巴囊肿尚无金标准治疗方法，且关于该主题的文献报道较少。无论是否联合TS，经皮导管引流都是安全有效的，尽管它可能会延长住院时间并增加发病率。
