title: Graft loss due to percutaneous sclerotherapy of a lymphocele using acetic acid after renal transplantation.
abstract: Development of lymphoceles after renal transplantation is a well-described complication that occurs in up to 40% of recipients. The gold standard approach for the treatment of symptomatic cases is not well defined yet. Management options include simple aspiration, marsupialization by a laparotomy or laparoscopy, and percutaneous sclerotherapy using different chemical agents. Those approaches can be associated, and they depend on type, dimension, and localization of the lymphocele. Percutaneous sclerotherapy is considered to be less invasive than the surgical approach; it can be used safely and effectively, with low morbidity, in huge, rapidly accumulating lymphoceles. Moreover, this approach is highly successful, and the complication rate is acceptable; the major drawback is a recurrence rate close to 20%. We herewith report a renal transplant case in which the patient developed a symptomatic lymphocele that was initially treated by ultrasound-guided percutaneous sclerotherapy with ethanol and thereafter using acetic acid for early recurrence. A few hours after injection of acetic acid in the lymphatic cavity, the patient started to complain of acute pain localized to the renal graft and fever. An ultrasound of the abdomen revealed thrombosis of the renal vein and artery. The patient was immediately taken to the operating room, where the diagnosis of vascular thrombosis was confirmed and the graft was urgently explanted. In conclusion, we strongly suggest avoiding the use of acetic acid as a slerosating agent for the percutaneous treatment of post-renal transplant lymphocele because, based on our experience, it could be complicated by vascular thrombosis of the kidney, ending in graft loss.
authors.affiliation: Department of Surgery and Transplantation, University School of Medicine, Udine, Italy. adanigl@hotmail.com
authors.forename: Gian Luigi
authors.initials: GL
authors.lastname: Adani
authors.forename: Umberto
authors.initials: U
authors.lastname: Baccarani
authors.forename: Vittorio
authors.initials: V
authors.lastname: Bresadola
authors.forename: Dario
authors.initials: D
authors.lastname: Lorenzin
authors.forename: Domenico
authors.initials: D
authors.lastname: Montanaro
authors.forename: Andrea
authors.initials: A
authors.lastname: Risaliti
authors.forename: Giovanni
authors.initials: G
authors.lastname: Terrosu
authors.forename: Massimo
authors.initials: M
authors.lastname: Sponza
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Bresadola
mesh_terms: D019342:Acetic Acid / Q000008:administration & dosage / Q000009:adverse effects*; D000328:Adult; D006083:Graft Occlusion, Vascular / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D006801:Humans; D007202:Indicators and Reagents / Q000008:administration & dosage / Q000009:adverse effects; D007668:Kidney / Q000098:blood supply / Q000187:drug effects / Q000473:pathology; D016030:Kidney Transplantation / Q000009:adverse effects*; D008210:Lymphocele / Q000628:therapy*; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis / Q000628:therapy; D012077:Renal Artery / Q000000981:diagnostic imaging / Q000601:surgery; D012082:Renal Veins / Q000000981:diagnostic imaging / Q000601:surgery; D015911:Sclerotherapy / Q000009:adverse effects*; D014463:Ultrasonography; D020246:Venous Thrombosis / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery
chemical_list: D007202:Indicators and Reagents; D019342:Acetic Acid