Lymphocele After Kidney Transplantation: Comparative Outcomes of Lymphatic Vessel Control Techniques in a Monocentric Experience

Background: Lymphoceles represent one of the most common surgical complications after kidney transplantation. Traditional prevention relies on meticulous lymphatic ligation, while energy-based vessel sealing devices such as the LigaSure™ Small Jaw have been increasingly adopted. However, evidence regarding their impact on postoperative lymphatic complications remains limited. Methods: This single-center retrospective cohort study included 1,735 consecutive adult kidney transplant recipients treated at the Padova University Hospital between 2008 and 2023. Patients were divided into two groups according to the lymphatic sealing technique: traditional suture ligation (pre-2016) and LigaSure™ Small Jaw (post-2016). Clinical, surgical, and immunologic variables were collected. The primary endpoint was lymphocele formation, defined as a perirenal fluid collection ≥5 cm in largest diameter confirmed by US or CT. Secondary outcome included hospital length of stay. A CUSUM analysis was performed to check for the presence of a possible learning curve. Multivariable logistic and linear regression models were used to adjust for confounders. Results: A total of 49 lymphoceles were identified (overall incidence 2.78%). The incidence was higher in the Ligasure cohort (3.2% vs. 1.7%), but this difference was not statistically significant after adjustment (aOR 1.63; 95% CI 0.83–3.22; p=0.159). The only independent predictor of lymphocele formation was the primary renal disease: Autosomal Dominant Polycystic Kidney Disease and Diabetic Nephropathy were associated with a more than threefold increased risk (aOR 3.14; p<0.001). No association was found with BMI, recipient age, donor type, immunosuppression, or operator variability. The CUSUM analysis showed no evidence of a learning curve, confirming immediate reproducibility of results. Length of stay did not differ between techniques after adjusting for complications such as DGF and rejection. Conclusions: The LigaSure™ Small Jaw system is a safe and reliable alternative to conventional suture ligation for lymphatic dissection in kidney transplantation. Although it does not reduce the incidence of lymphoceles, it performs comparably to standard ligation even in a modern, more complex patient population. These findings suggest that energy-based sealing devices may represent a safe and effective alternative to conventional ligation; however, further prospective studies are required before their use can be established as a standard of care in kidney transplantation surgery.