Large Obstructive Lymphocele After Kidney Transplantation

Introduction: Lymphocele is a common surgical complication in post-kidney transplantation with an incidence rate of 0.6% to 61%. Symptomatic lymphoceles, however, have a lower incidence rate at 0.03% to 26%, averaging 5.2%. Most lymphoceles are small, asymptomatic, and resolve on their own, but large lymphoceles (>6 cm) have an increased morbidity and often require urgent intervention. Case Description: A 44-year-old Filipino woman with diabetic kidney disease underwent successful kidney transplantation at the right iliac fossa, with a serum creatinine of 0.6 mg/dL upon hospital discharge. On the 15th post-transplant day, she was readmitted due to a painful right lower quadrant mass, decreased urine output, and elevated serum creatinine of 3.68 mg/dL. Renal graft ultrasound showed a 745 mL perigraft fluid collection (15.4 × 16 × 5.8 cm), which was managed with ultrasound-guided percutaneous drainage followed by sclerotherapy. The procedure alleviated her symptoms, improved urine output, and lowered serum creatinine to 2.1 mg/dL. One month later, her serum creatinine further decreased to 1.06 mg/dL, with an average urine output of 3L/day. Repeat renal graft ultrasound revealed a residual fluid collection of 30 mL. Discussion: Lymphoceles are a common post-kidney transplantation complication, often resolving spontaneously. However, symptomatic cases require timely diagnosis and intervention to prevent morbidity. While percutaneous aspiration of the lymphocele is a less invasive treatment option, the high recurrence rate of 33% with aspiration alone and the lymphocele’s significant size (>10 cm) in this particular case warranted ultrasound-guided percutaneous drainage followed by sclerotherapy instead. Close post-treatment monitoring is essential, as lymphoceles tend to recur within weeks to months.