Unusual Variants of Postrenal Transplant Lymphocele: Our Experience and Review of Literature

Postrenal transplant lymphocele is usually a peri-graft collection of fluid in a nonepithelized extra-peritoneal cavity between the allograft renal capsule and surrounding structures (superomedially by peritoneum and anterolaterally by the abdominal wall and pelvic wall). Most often, lymphoceles are found either superolateral or inferior to the allograft. Herein, we report the presentation and management of lymphocele in two cases with atypical anatomical localization. We have analyzed the details of two patients who had postrenal transplant lymphocele collection in atypical anatomical locations.

Case 1:

A 40-year-old male underwent ABO compatible live-related renal transplantation in 2019. He presented with rising serum creatinine in 2024 for which renal biopsy was done. Histopathology findings showed no evidence of rejection. After 4 weeks of biopsy, he presented with a complaint of early postprandial fullness. On evaluation, a large subcapsular collection was seen anterolateral to the allograft.

Case 2:

A 39-year-old male presented with swelling in the abdomen in the allograft region after 4 weeks of live-related renal transplantation. On evaluation, a hypoechoic collection was seen in the anterior abdominal wall in the intermuscular and subcutaneous planes. The analysis of fluid collection in both cases was consistent with lymphocele like composition. Both patients were initially managed by drainage and sclerotherapy but finally responded well to laparoscopic deroofing as definitive management. The lymphoceles in an atypical anatomical location such as in the intermuscular or subcutaneous planes or subcapsular region can be successfully managed with laparoscopic deroofing.