Injuries and Complications of the Lymphatic System Following Renal Transplantation

Abstract

Although major lymph trunks of the recipient are transected during renal transplantation, no
lymphat ic complicat ions per se have been reported. We believe that these complicat ions a re not
infrequent but have not been recognized as sud1 because no lymphograms were performed. This
report deals with fou r patients who developed draining sinuses, pelvic abscesses and other masses
in whom the correct diagnos is was established by lymphography; nam ely, that the complications
were caused by continuous lymphatic drainage from lymphatic vessels.
The purpose of this paper is to describe four patients who underwent renal transplantation
and developed complications directly r elated to surgical injury of pelvic
lymph vessels. Review of the literature reveals a great variety of possible post-operative
( 1, i , 9) complications which may develop after renal transplantation, but relationship
of such complications to the lymphatic system has rarely been stressed ( 4, 8). This is
particularly surprising since the surgery needed for the placement of a transplanted
kidney requires transection of major lymphati cs of the external iliac chain. During the
preparation of the vascular pedicle the lymphatic and aureolar ti ssue surrounding the
external iliac and hypogastric vessel must be excised. Failure to identify and ligate such
vessels may result in post-operative leakage into potential pelvic spaces. Lymphography
correctly established the relationships of draining sinuses and/or pelvic masses which
developed in four patients who underwent renal transplantation . Brief histories of these