Intraoperative placing of drains decreases the incidence of lymphocele and deep vein thrombosis after renal transplantation

OBJECTIVE To investigate the effect of placing a prophylactic drain during renal transplantation on the incidence of lymphocele, wound complication and deep venous thrombosis (DVT) in renal transplant recipients induced with sirolimus vs calcineurin inhibitors (CNI), as sirolimus-based immunosuppression is a risk factor for the formation of fluid collections after transplantation. PATIENTS AND METHODS We analysed 165 consecutive adult renal transplant patients at our institution between January 2004 and February 2005. Group 1 (84) did not receive an intraoperative drain and group 2 (81) did. Recipients were analysed within each group based on immunosuppression (sirolimus or CNI) and whether they had wound complication, fluid collection, lymphocele treatment, or DVT. RESULTS In group 1 and 2, respectively, the wound complication rate was 22.6% vs 13.6% (P = 0.134), the fluid collection rate 45.2% vs 16.% (P < 0.001), the lymphocele treatment rate 19.0% vs 2.5% (P = 0.001) the DVT rate 14.3% vs 4.9% (P = 0.043) the fluid collection rate (for CNI) 26.5% vs 16.0% (P = 0.246), the lymphocele treatment rate (for CNI) 5.9% vs 0% (P = 0.084), the fluid collection rate (sirolimus) 58.0% vs 16.1% (P < 0.001) and lymphocele treatment rate (sirolimus) 28% vs 6.5% (P = 0.018). Multivariate analysis of risk factors for fluid collection showed significance for no drain (odds ratio 3.30, P = 0.002), associated wound complication (2.41, P = 0.041) and sirolimus (2.48, P = 0.015). CONCLUSIONS Placing a drain during transplantation decreased the incidence of fluid collection, lymphocele treatment and DVT. The reduction of fluid collection and lymphocele were significant for patients treated with sirolimus. We recommend placing a drain in patients undergoing induction with sirolimus-based immunosuppression.