Login to Access Video or Poster Abstract: MP74-10
Sources of Funding: None.

Introduction

Postoperative peri-nephric fluid collections are common after pediatric renal transplantation (RT), and may be caused by clinical entities such as urinoma, hematoma, and lymphocele. These collections are usually monitored with serial ultrasounds. Size, etiology, extrinsic ureteral obstruction and/or the presence of symptoms dictate management. We hypothesized that these fluid collections rarely require intervention, and gain little benefit from close follow-up with imaging in the presence of stable clinical status (asymptomatic with stable renal function) and absence of hydronephrosis.

Methods

Retrospective review was performed of all children who underwent pediatric RT at our institution within the last five years (2010-2014) and monitored at least 1 month postoperatively. Peri-nephric fluid collections on postoperative renal ultrasounds were measured in 3 axes and correlated with clinical parameters and symptomatology. Indicated interventions including image-guided drainage and surgery were captured.

Results

103 children underwent RT (59 deceased and 44 living-related donor) over this period, at a mean age of 10.6±5.4 years. Only 37 patients (36%) had no peri-nephric collections on ultrasound at two weeks postoperatively. Sixty-six patients (64%) had fluid collections, 14 of which underwent intervention: 9 lymphoceles (8.7%), 3 infected hematomas (2.9%), and 2 urinomas (1.9%). Four patients with lymphoceles underwent laparoscopic marsupialization after failed drainage and/or sclerotherapy. The average fluid collection volume was 169 cm³; 618 cm³ in the intervention group compared to 46 cm³ in those observed.

Conclusions

Peri-nephric fluid collections are common after pediatric renal transplantation, the majority of which do not require intervention. Larger volume fluid collections were associated with intervention and are usually secondary to lymphoceles.

Funding

None.