Infected Lymphocele Post-Transplant Drainage — ESENeph MCQ

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ModerateTransplantationInfected Lymphocele Post-Transplant DrainageESENeph

A 65-year-old man develops fever (38.5°C), pain over his transplant kidney, and rising creatinine 3 months post-transplant. Transplant ultrasound shows a perinephric fluid collection. Aspiration reveals turbid fluid with WCC 15,000/mm3 and Gram-negative bacilli. What is the most likely diagnosis?

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Correct answer: C — Perinephric abscess/infected lymphocele

A perinephric fluid collection with infection signs (fever, turbid aspirate, Gram-negative organisms) in the early post-transplant period is most likely an infected lymphocele or perinephric abscess. Lymphoceles are the most common perinephric fluid collection post-transplant (5-20% incidence), occurring from disrupted lymphatic channels during iliac fossa dissection. Most are asymptomatic, but they can become infected (particularly with Gram-negative organisms from the urinary tract) or cause graft compression with hydronephrosis. Management of an infected collection requires percutaneous drainage with catheter placement, IV antibiotics, and consideration of surgical marsupialisation (laparoscopic peritoneal window) if recurrent. Immunosuppression may need temporary reduction.

Reference: UKKA/BTS 2018 – Transplant Surgical Complications; KDIGO 2009 – Transplant Guideline