Tlili S, Ghabi H, Mami I, Kaaroud H, Rais L, Mohamed Karim ZR. Lymphocele after kidney transplantation: Incidence, associated factors and outcomes. World J Nephrol 2026; 15(1): 111612 [DOI: 10.5527/wjn.v15.i1.111612]
Corresponding Author of This Article
Syrine Tlili, Assistant Professor, Department of Nephrology, La Rabta University Hospital, Street Jebberi, Tunis 1007, Tunisia. syrine.tlili@fmt.utm.tn
Research Domain of This Article
Urology & Nephrology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Syrine Tlili, Hiba Ghabi, Department of Nephrology, La Rabta University Hospital, Tunis 1007, Tunisia
Ikram Mami, Hayet Kaaroud, Lamia Rais, Zouaghi Rabta Mohamed Karim, Department of Nephrology, Dialysis and Transplantation, La Rabta Hospital, Tunis 1007, Tunisia
Hayet Kaaroud, Research Laboratory in Renal Pathology LR00SP01, Medicine School of Tunis, Tunis 1007, Tunisia
Co-first authors: Syrine Tlili and Hiba Ghabi.
Author contributions: Tlili S and Karim ZRM conceived and designed the study; Tlili S, Ghabi H and Mami I collected and analyzed the clinical data; Rais L and Kaaroud H contributed to the interpretation of results and provided nephropathological expertise; Tlili S drafted the initial manuscript; Tlili S and Ghabi H have made crucial and indispensable contributions towards the completion of the project and thus qualified as the co-first authors of the paper; all authors critically revised the manuscript for important intellectual content and approved the final version for submission.
Institutional review board statement: This study was approved by the Ethics Committee of La Rabta Hospital. As this was a retrospective study using anonymized data, informed consent was waived in accordance with institutional and national guidelines.
Informed consent statement: Written informed consent for the use of clinical data for research and publication purposes was obtained from all participants included in this study.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest related to this manuscript.
Data sharing statement: Not applicable.
Corresponding author: Syrine Tlili, Assistant Professor, Department of Nephrology, La Rabta University Hospital, Street Jebberi, Tunis 1007, Tunisia. syrine.tlili@fmt.utm.tn
Received: July 4, 2025 Revised: July 28, 2025 Accepted: January 12, 2026 Published online: March 25, 2026 Processing time: 253 Days and 9.9 Hours
Abstract
BACKGROUND
The outcome of renal transplantation is influenced by the occurrence of various complications, including urological. One of the most frequently occurring complications is lymphocele with an incidence of 0.6% to 51%. In fact, Lymphocele represents a notable postoperative complication that can lead to acute dysfunction of the renal graft or compression of adjacent venous structures. Despite its clinical relevance, the risk factors associated with its development remain inconsistently reported in the literature.
AIM
To evaluate the incidence, identify potential risk factors, and assess the clinical outcomes related to post-transplant lymphocele formation.
METHODS
We analyzed 86 consecutive renal transplant recipients from 2010 to 2019. All recipients had undergone protocol screening ultrasound scan at first week after surgery and 3 months post-transplant. We analyzed risk factors for lymphocele formation. Comparison between lymphocele and no-lymphocele groups was made with linear logistic regression analyses.
RESULTS
Among the 86 kidney transplant recipients, 15 patients (17.4%) developed a lymphocele, with a median onset of 30 days post-transplantation (range: 30-330 days). The condition was asymptomatic in the majority of cases (14 patients, 93%), while one patient (7%) presented with ipsilateral lower limb lymphedema, which led to the diagnosis. Therapeutic intervention was necessary in four cases. Sclerotherapy using a povidone-iodine solution was performed in three patients, while one patient underwent combined sclerotherapy and percutaneous drainage.
Multivariate analysis identified two independent risk factors: Warm ischemia time exceeding 30 minutes [P = 0.011; odds ratio (OR) = 1.103; 95%CI: 1.023-1.109] and donor age over 50 years (P = 0.041; OR = 1.072; 95%CI: 1.023-1.146). Renal function at one year was comparable between patients who developed a lymphocele and those who did not.
CONCLUSION
Our findings suggest that improved surgical techniques and optimized immunosuppressive management could contribute to reducing the incidence of lymphocele and enhancing post-transplant renal outcomes.
Core Tip: Lymphocele is a frequent complication after kidney transplantation, but its risk factors remain poorly studied in North African populations. This retrospective study of Tunisian kidney transplant recipients identified prolonged warm ischemia time and older donor age as independent predictors of lymphocele formation. The findings emphasize the importance of targeted preventive strategies in this specific regional context to improve graft outcomes and patient care.
