Floseal hemostatic matrix reduces symptomatic lymphoceles after renal transplantation

Abstract

INTRODUCTION AND OBJECTIVES: Lymphoceles are common after kidney transplantation with an incidence ranging from 0.6 to 26%. We evaluate the efficacy of novel use of FloSeal® hemostatic matrix in preventing symptomatic lymphoceles requiring intervention in two renal transplant centers in the territory. METHODS: This was a two-center, matched comparison of cadaveric or living-related renal transplantation performed in patients > 18 years of age between January 2011 and August 2015. Off-label application of FloSeal started since May 2013 in one center and December 2013 in the other. FloSeal (5ml per case) was applied to the graft hilar area and the peri-iliac vessel lymphatic area after graft reperfusion, and then gently compressed for two minutes without any flushing. The incidence of symptomatic lymphoceles were compared in the two groups and evaluated with Kaplan Meier method. Different potential risk factors for lymphocele formation were also reviewed and evaluated with logistic regression analysis. RESULTS: A total of 218 patients (mean age of 44.0 years and mean follow-up of 30.3 months) underwent cadaveric (186) or living-related (32) renal transplant in the period (94 with FloSeal, 124 without FloSeal). There was 8 (8.5%) symptomatic lymphoceles in the FloSeal group compared with 29 (23.4%) in the non-FloSeal group (p=0.004). Duration of renal replacement therapy and duration of peritoneal dialysis were also significantly associated with symptomatic lymphoceles in univariate analysis for risk factor analysis, but upon multivariate analysis using logistic regression, FloSeal use was the only independent factor (OR = 0.31 [CI 0.13-0.73], p = 0.007) for symptomatic lymphoceles. Symptomatic lymphoceles in FloSeal group presented and were intervened significantly earlier than in non-FloSeal group. No adverse events associated with FloSeal use were reported. CONCLUSIONS: Our data suggest that the use of FloSeal can reduce symptomatic lymphoceles in renal transplantation. Further cost analysis is useful in evaluating its cost-effectiveness in lymphocele treatment.