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Evaluation of postoperative lymphocele according to amounts and symptoms by using 3-dimensional CT volumetry in kidney transplant recipients

View Article: PubMed Central - PubMed

ABSTRACT

Purpose: To analyze the risk factors for postoperative lymphocele, for predicting and preventing complications.

Methods: We evaluated 92 kidney transplant recipients with multidetector CT (MDCT) at 1-month posttransplantation. From admission and 1-month postoperative records, data including diabetes, dialysis type, immunosuppressant use, steroid pulse therapy, and transplantation side were collected. Lymphocele volume was measured with 3-dimensional reconstructed, nonenhanced MDCT at one month postoperatively. The correlations between risk factors and lymphocele volume and between risk factors and symptomatic lymphocele (SyL) were analyzed. The cutoff was calculated by using the receiver operating characteristic (ROC) curve for SyL volume.

Results: Among 92 recipients, the mean volume was 44.53 ± 176.43 cm3 and 12 had SyL. Univariable analysis between risk factors and lymphocele volume indicated that donor age, retransplantation, and inferiorly located lymphocele were statistically significant. The ROC curve for SyL showed that 33.20 cm3 was the cutoff, with 83.3% sensitivity and 93.7% specificity. On univariable analysis between risk factors and SyL, steroid pulse, inferiorly located lymphocele, and >33.20 cm3 were statistically significant. Multivariable analysis indicated that steroid pulse, >33.20 cm3, and serum creatinine level at one month were significant factors.

Conclusion: Risk factors including donor age, retransplantation, steroid pulse therapy, and inferiorly located lymphocele are important predictors of large lymphoceles or SyL. In high-risk recipients, careful monitoring of renal function and early image surveillance such as CT or ultrasound are recommended. If the asymptomatic lymphocele is >33.20 cm3 or located inferiorly, early interventions can be considered while carefully observing the changes in symptoms.

No MeSH data available.


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An example multidetector CT image of a postoperative lymphocele in a kidney transplant recipient. (A) Axial image (white arrow). (B) Three-dimensional reconstruction and automatic volume assessment.
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Figure 1: An example multidetector CT image of a postoperative lymphocele in a kidney transplant recipient. (A) Axial image (white arrow). (B) Three-dimensional reconstruction and automatic volume assessment.

Mentions: At 4–6 weeks postoperatively, after an MDCT scan was performed, the double-J catheter was removed. By using an MDCT scan taken 1 month postoperatively, regardless of symptoms, the quantitative volume of lymphocele was measured in the D reconstruction images (Fig. 1). To obtain 3D volumetry, CT examinations of the abdomen were performed with a 128-slice MDCT scanner (Definition AS Plus; Siemens Healthcare, Forchheim, Germany) without contrast agent administration. After the scan, an automatic raw-data analysis tool (Syngo and Somaris; Siemens Medical Solutions, Erlangen, Germany) was used to reconstruct the transverse CT data. Next, 2 reviewers (HJ, SHH) assessed the analysis of the abdominal CT images by using a commercial software (TeraRecon iNtuition, TeraRecon, Foster City, CA, USA). By using the free region of interest for hand drawing, the lymphocele images were manually collected within the overlay images, and the lymphocele volume was automatically assessed in cubic centimeters and expressed on the 3D image.


Evaluation of postoperative lymphocele according to amounts and symptoms by using 3-dimensional CT volumetry in kidney transplant recipients
An example multidetector CT image of a postoperative lymphocele in a kidney transplant recipient. (A) Axial image (white arrow). (B) Three-dimensional reconstruction and automatic volume assessment.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5016603&req=5

Figure 1: An example multidetector CT image of a postoperative lymphocele in a kidney transplant recipient. (A) Axial image (white arrow). (B) Three-dimensional reconstruction and automatic volume assessment.
Mentions: At 4–6 weeks postoperatively, after an MDCT scan was performed, the double-J catheter was removed. By using an MDCT scan taken 1 month postoperatively, regardless of symptoms, the quantitative volume of lymphocele was measured in the D reconstruction images (Fig. 1). To obtain 3D volumetry, CT examinations of the abdomen were performed with a 128-slice MDCT scanner (Definition AS Plus; Siemens Healthcare, Forchheim, Germany) without contrast agent administration. After the scan, an automatic raw-data analysis tool (Syngo and Somaris; Siemens Medical Solutions, Erlangen, Germany) was used to reconstruct the transverse CT data. Next, 2 reviewers (HJ, SHH) assessed the analysis of the abdominal CT images by using a commercial software (TeraRecon iNtuition, TeraRecon, Foster City, CA, USA). By using the free region of interest for hand drawing, the lymphocele images were manually collected within the overlay images, and the lymphocele volume was automatically assessed in cubic centimeters and expressed on the 3D image.

View Article: PubMed Central - PubMed

ABSTRACT

Purpose: To analyze the risk factors for postoperative lymphocele, for predicting and preventing complications.

Methods: We evaluated 92 kidney transplant recipients with multidetector CT (MDCT) at 1-month posttransplantation. From admission and 1-month postoperative records, data including diabetes, dialysis type, immunosuppressant use, steroid pulse therapy, and transplantation side were collected. Lymphocele volume was measured with 3-dimensional reconstructed, nonenhanced MDCT at one month postoperatively. The correlations between risk factors and lymphocele volume and between risk factors and symptomatic lymphocele (SyL) were analyzed. The cutoff was calculated by using the receiver operating characteristic (ROC) curve for SyL volume.

Results: Among 92 recipients, the mean volume was 44.53 ± 176.43 cm3 and 12 had SyL. Univariable analysis between risk factors and lymphocele volume indicated that donor age, retransplantation, and inferiorly located lymphocele were statistically significant. The ROC curve for SyL showed that 33.20 cm3 was the cutoff, with 83.3% sensitivity and 93.7% specificity. On univariable analysis between risk factors and SyL, steroid pulse, inferiorly located lymphocele, and >33.20 cm3 were statistically significant. Multivariable analysis indicated that steroid pulse, >33.20 cm3, and serum creatinine level at one month were significant factors.

Conclusion: Risk factors including donor age, retransplantation, steroid pulse therapy, and inferiorly located lymphocele are important predictors of large lymphoceles or SyL. In high-risk recipients, careful monitoring of renal function and early image surveillance such as CT or ultrasound are recommended. If the asymptomatic lymphocele is >33.20 cm3 or located inferiorly, early interventions can be considered while carefully observing the changes in symptoms.

No MeSH data available.


Related in: MedlinePlus