title: Fibrin Glue Injections: A Minimally Invasive and Cost-Effective Treatment for Post-Renal Transplant Lymphoceles and Lymph Fistulas.
abstract: Pelvic lymphoceles/lymph fistulas are commonly observed after kidney allotransplantation, especially when the kidney is placed in a retroperitoneal position. While the majority are <5 cm in diameter and resolve without intervention, some may continue to enlarge, and cause local or systemic symptoms or graft dysfunction. Among 1662 recipients of both living and deceased donor kidney transplants between January 2003 and July 2014, we found 46 (2.7%) patients with symptomatic lymphoceles requiring intervention. We studied the clinical outcomes and charges for three treatment modalities including open surgical drainage (22), laparoscopic surgical drainage (11), and percutaneous fibrin glue injections into the drained lymphocele cavity (13). The patient demographics and clinical characteristics were comparable for each treatment group, although maintenance immunosuppressive drugs differed by era. We found fibrin glue injections resulted in significantly lower (p = 0.04) rates of recurrence (1; 7.7%) than either laparoscopic (6; 54%) or open surgical drainage (6; 27.3%). In addition, fibrin glue injections generated significantly (p < 0.001) lower median ($4559) charges compared to either laparoscopic ($26,330) or open surgical drainage ($23,758). Fibrin glue treatment has the advantage of being an outpatient procedure, performed with the patient under local anesthesia, and does not incur the expense of an operative procedure or hospital admission associated with laparoscopic or open surgery.
authors.affiliation: Renal Transplant Program, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH.
authors.forename: N
authors.initials: N
authors.lastname: Presser
authors.affiliation: Renal Transplant Program, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH.
authors.forename: H
authors.initials: H
authors.lastname: Kerr
authors.affiliation: Renal Transplant Program, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH.
authors.forename: T
authors.initials: T
authors.lastname: Gao
authors.affiliation: Renal Transplant Program, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH.
authors.forename: M
authors.initials: M
authors.lastname: Begala
authors.affiliation: Renal Transplant Program, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH.
authors.forename: S
authors.initials: S
authors.lastname: Paschal
authors.affiliation: Renal Transplant Program, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH.
authors.forename: D A
authors.initials: DA
authors.lastname: Shoskes
authors.affiliation: Renal Transplant Program, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH.
authors.forename: S M
authors.initials: SM
authors.lastname: Flechner
mesh_terms: D000328:Adult; D002404:Catheterization; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000008:administration & dosage*; D005402:Fistula / Q000191:economics* / Q000209:etiology / Q000628:therapy*; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000191:economics / Q000209:etiology / Q000628:therapy; D006085:Graft Survival; D017048:Health Care Costs; D006801:Humans; D007275:Injections, Intravenous; D007676:Kidney Failure, Chronic / Q000601:surgery; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000009:adverse effects*; D010535:Laparoscopy / Q000379:methods; D008210:Lymphocele / Q000191:economics* / Q000209:etiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D014014:Tissue Adhesives / Q000008:administration & dosage
chemical_list: D015718:Fibrin Tissue Adhesive; D014014:Tissue Adhesives
keywords: clinical research / practice; complication: surgical / technical; kidney transplantation / nephrology; surgical technique