Percutaneous drainage of pelvic lymphatic fluid collections in the renal transplant patient.

Seventeen renal transplant patients with pelvic lymphatic fluid collections were treated with percutaneous drainage. Eleven of 16 patients with lymphoceles (69%) were successfully managed without surgery, although seven of these patients required repeat catheter insertions, and three patients developed local infections. The patient with an ovarian cystadenoma was treated with surgery. The mean duration of catheter insertion was ten days for initial drainage and 16 days for repeat drainage. Elevated serum creatinines decreased in 14 of the patients with lymphoceles (88%), including all five patients without pelvocaliectasis, but never returned to baseline in six instances. This observation may reflect the inadequate therapy of frequently encountered concurrent renal parenchymal abnormalities (rejection, cyclosporine toxicity, acute tubular necrosis). While percutaneous management of lymphoceles is technically easy and usually ultimately effective, the interventional radiologist should be prepared for long duration of catheter insertions, repeat interventions, and variable clinical courses. Differentiation of lymphoceles from other fluid collections, such as cystic ovarian neoplasms, may be difficult.