Single Cohort Study: ABO-incompatible Kidney Transplant Recipients Have a Higher Risk of Lymphocele Formation

Overview

Journal Langenbecks Arch Surg

Specialty General Surgery

Date 2019 Aug 29

PMID 31456076

Citations 3

Authors

Bernd Martin Janigen

Chiara Salabe

Torben Glatz

Oliver Thomusch

Claudia Lassle

Stefan Fichtner-Feigl

Stefan Zschiedrich

Przemyslaw Pisarski

Affiliations

Soon will be listed here.

Abstract

Purpose: Since 2004, ABO-incompatible kidney transplantation (ABOi KTx) became an established procedure to expand the living donor pool in Germany. Currently, ABOi KTx comprises > 20% of all living donor KTx. Up to September 2015, > 100 ABOi KTx were performed in Freiburg. Regarding lymphocele formation, only scarce data exist.

Methods: Between April 2004 and September 2015, 106 consecutive ABOi and 277 consecutive ABO-compatible kidney transplantations (ABOc KTx) were performed. Two ABOi and 117 ABOc recipients were excluded due to differences in immunosuppression. One hundred-four ABOi and 160 ABOc KTx patients were analyzed concerning lymphocele formation.

Results: The incidence of lymphoceles in ABOi KTx was 25.2% and 10.6% in ABOc KTx (p = 0.003). A major risk factor appeared the frequency of ≥ 8 preoperative immunoadsorption and/or plasmapheresis sessions (OR 5.61, 95% CI 2.31-13.61, p < 0.001). Particularly, these ABOi KTx recipients had a distinctly higher risk of developing lymphocele (40.0% vs. 19.2%, p = 0.044). IA/PE sessions on day of transplantation (no lymphocele 20.0% vs. lymphocele 28.6%, p = 0.362) or postoperative IA/PE sessions (no lymphocele 25.7% vs. lymphocele 24.1%, p = 1.0) showed no influence on formation of lymphoceles.

Conclusion: In ABOi KTx, the incidence of lymphocele formation is significantly increased compared to ABOc KTx and leads to more frequent surgical reinterventions without having an impact on graft survival.

Citing Articles

Outcomes of ABO-incompatible kidney transplants with very high isoagglutinin titers: a single-center experience and literature review.

Naciri Bennani H, Bobo Barry K, Noble J, Malvezzi P, Jouve T, Rostaing L Front Immunol. 2024; 15:1504495.

PMID: 39687613 PMC: 11647008. DOI: 10.3389/fimmu.2024.1504495.

Non-antigen-specific Immunoadsorption Is a Risk Factor for Severe Postoperative Infections in ABO-Incompatible Kidney Transplant Recipients.

Matuschik L, Seifert G, Lammich K, Holzner P, Tanriver Y, Fichtner-Feigl S Transpl Int. 2024; 37:12263.

PMID: 38550626 PMC: 10974667. DOI: 10.3389/ti.2024.12263.

Experiences and Short-Term Outcomes of Kidney Transplantation During the Coronavirus Disease 2019 Pandemic From a Medium-Volume Transplantation and Superregional Coronavirus Disease 2019 Treatment Center.

Laessle C, Schneider J, Pisarski P, Fichtner-Feigl S, Janigen B Transplant Proc. 2021; 53(4):1146-1153.

PMID: 33640166 PMC: 7816559. DOI: 10.1016/j.transproceed.2021.01.036.

References

Schaefer B, Tonshoff B, Schmidt J, Golriz M, Mehrabi A, Gombos P . Bleeding complications in pediatric ABO-incompatible kidney transplantation. Pediatr Nephrol. 2012; 28(2):327-32. DOI: 10.1007/s00467-012-2302-x. View

Wilpert J, Fischer K, Pisarski P, Wiech T, Daskalakis M, Ziegler A . Long-term outcome of ABO-incompatible living donor kidney transplantation based on antigen-specific desensitization. An observational comparative analysis. Nephrol Dial Transplant. 2010; 25(11):3778-86. DOI: 10.1093/ndt/gfq229. View

Lopau K, Syamken K, Rubenwolf P, Riedmiller H, Wanner C . Impact of mycophenolate mofetil on wound complications and lymphoceles after kidney transplantation. Kidney Blood Press Res. 2010; 33(1):52-9. DOI: 10.1159/000289573. View

Hamza A, Fischer K, Koch E, Wicht A, Zacharias M, Loertzer H . Diagnostics and therapy of lymphoceles after kidney transplantation. Transplant Proc. 2006; 38(3):701-6. DOI: 10.1016/j.transproceed.2006.01.065. View

Kim M, Jun K, Hwang J, Kim J, Chung B, Choi B . Risk factors for postoperative bleeding in ABO-incompatible kidney transplantation. Clin Transplant. 2015; 29(4):365-72. DOI: 10.1111/ctr.12525. View

Conrad S, Schneider A, Gonnermann D, Ganama A, Tenschert W, Huland H . [Urologic complications after kidney transplantation. Experiences in a center with 539 recipients]. Urologe A. 1994; 33(5):392-400. View

Song S, Lee J, Kim B, Kim S, Lee J, Jeong H . Successful launch of an ABO-incompatible kidney transplantation program to overcome the shortage of compatible living donors: experience at a single center . Clin Nephrol. 2017; 88(9):117-123. DOI: 10.5414/CN109114. View

Lundin C, Bersztel A, Wahlberg J, Wadstrom J . Low molecular weight heparin prophylaxis increases the incidence of lymphocele after kidney transplantation. Ups J Med Sci. 2002; 107(1):9-15. DOI: 10.3109/2000-1967-137. View

Orlic L, Mikolasevic I, Jakopcic I, Grskovic A, Jelic Pranjic I, Racki S . Body mass index: short- and long-term impact on kidney transplantation. Int J Clin Pract. 2015; 69(11):1357-65. DOI: 10.1111/ijcp.12715. View

10.

Zschiedrich S, Kramer-Zucker A, Janigen B, Seidl M, Emmerich F, Pisarski P . An update on ABO-incompatible kidney transplantation. Transpl Int. 2014; 28(4):387-97. DOI: 10.1111/tri.12485. View

11.

Zschiedrich S, Janigen B, Dimova D, Neumann A, Seidl M, Hils S . One hundred ABO-incompatible kidney transplantations between 2004 and 2014: a single-centre experience. Nephrol Dial Transplant. 2015; 31(4):663-71. DOI: 10.1093/ndt/gfv388. View

12.

Tyden G, Kumlien G, Fehrman I . Successful ABO-incompatible kidney transplantations without splenectomy using antigen-specific immunoadsorption and rituximab. Transplantation. 2003; 76(4):730-1. DOI: 10.1097/01.TP.0000078622.43689.D4. View

13.

Koessler J, Kobsar A, Kuhn S, Koessler A, Yilmaz P, Weinig E . The effect of immunoadsorption with the Immusorba TR-350 column on coagulation compared to plasma exchange. Vox Sang. 2014; 108(1):46-51. DOI: 10.1111/vox.12191. View

14.

Pillot P, Bardonnaud N, Lillaz J, Delorme G, Chabannes E, Bernardini S . Risk factors for surgical complications after renal transplantation and impact on patient and graft survival. Transplant Proc. 2012; 44(9):2803-8. DOI: 10.1016/j.transproceed.2012.09.030. View

15.

Schwartz J, Stegall M, Kremers W, Gloor J . Complications, resource utilization, and cost of ABO-incompatible living donor kidney transplantation. Transplantation. 2006; 82(2):155-63. DOI: 10.1097/01.tp.0000226152.13584.ae. View

16.

Hwang J, Kim S, Choi B, Yang C, Kim Y, Moon I . Short-term results of ABO-incompatible living donor kidney transplantation: comparison with ABO-compatible grafts. J Korean Surg Soc. 2011; 81(1):10-8. PMC: 3204555. DOI: 10.4174/jkss.2011.81.1.10. View

17.

Lentine K, Axelrod D, Klein C, Simpkins C, Xiao H, Schnitzler M . Early clinical complications after ABO-incompatible live-donor kidney transplantation: a national study of Medicare-insured recipients. Transplantation. 2014; 98(1):54-65. PMC: 4411309. DOI: 10.1097/TP.0000000000000029. View

18.

Renner F, Czekalinska B, Kemkes-Matthes B, Feustel A, Stertmann W, Padberg W . Postoperative bleeding after AB0-incompatible living donor kidney transplantation. Transplant Proc. 2010; 42(10):4164-6. DOI: 10.1016/j.transproceed.2010.09.056. View

19.

Mokos I, Basic-Jukic N, Kastelan Z, Kes P, Pasini J . Influence of long-term dialysis treatment on operative complications after renal transplantation. Transplant Proc. 2010; 42(7):2531-3. DOI: 10.1016/j.transproceed.2010.04.061. View

20.

Sivakumaran P, Vo A, Villicana R, Peng A, Jordan S, Pepkowitz S . Therapeutic plasma exchange for desensitization prior to transplantation in ABO-incompatible renal allografts. J Clin Apher. 2009; 24(4):155-60. DOI: 10.1002/jca.20206. View