Introduction: Lymphocele is a special complication following kidney transplantation. The authors examined the factors associated with an increased occurrence of clinically significant perinephric fluid collections and/or lymphoceles among sirolimus-treated renal transplant recipients. Aim: From the point of view of the lymphocele a comparison was made for the risks and benefits of the conventional and a newer immunosuppressive combination. Methods: At the University of Texas in Houston in a retrospective study the incidence, predisposing factors, and consequences of these fluid collections among patients treated with sirotimus-cyclosporine-prednisone (n = 354, Group I) versus cyclosporine-prednisone-azathioprine (n = 136, Group II) were compared. Results: More Group I patients (135/354; 38.1%) displayed perinephric fluid collections than Group II patients (24/136; 17.6%; p < 0.001). In both subgroups the serum creatinine levels were elevated at the time of diagnosis from a nadir of 179.5 ± 141.7 to 359.9 ± 259.6 mmol/l (Group III, sirolimus treated) and from 222.6 ± 205.9 to 383.7 ± 255.2 mmol/l (Group IV, sirolimus free). A significantly greater number of patients required treatment for lymphoceles among Group I (15.8%; 56/354) versus Group II recipients (4.4%; 6/136; p < 0.001). Single or repeated percutaneous drainage procedures successfully treated 35 Group I patients versus all 6 Group IV patients (p = 0.033). No patients in Group II versus 21 patients in Group I underwent surgical procedures (p < 0.001). A significantly higher rate and higher histologic grade of acute rejection episodes, particularly proximate to the onset of the lymphocele, occurred among Group IV patients, namely 54.2% (13/24) versus 21.4% (29/135) Group III patients (p < 0.001). Additionally we report the case of a 29-year-old patient who underwent a lymphocele fenestration with omentoplasty 8 years after his transplantation. Despite an Influenza A + Chlamydia. pneumonia and acute rejection which was followed by a GI bleeding and stomach resection he fiffly recovered and is doing well with an excellent kidney fimction a year after. Conclusions: Addition of sirolimus to a cyclosporine-prednisone regimen resulted in both a higher incidence and a requirement for more aggressive treatment of pcrincphric fluid collections and/or lymphoceles with a much lower acute rejection frequency.
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