Complications of Autologous Lymph-node Transplantation for Limb Lymphoedema

Complications of Autologous Lymph-node Transplantation for Limb Lymphoedema


European Journal of Vascular and Endovascular Surgery
Available online 8 January 2013

·S. Vignes, , M. Blanchard, A. Yannoutsos, M. Arrault
Department of Lymphology, Centre National de Référence des Maladies Vasculaires 
Rares (lymphœdèmes primaires), Hôpital Cognacq-Jay, 15, rue Eugène Millon, 75015 
Paris, France

Objective

This study aims to assess potential complications of autologous lymph-node transplantation (ALNT) to treat limb lymphoedema.

Design

Prospective, observational study.

Method

All limb-lymphoedema patients, followed up in a single lymphology department, who decided to undergo ALNT (January 2004–June 2012) independently of our medical team, were included.

Results

Among the 26 patients (22 females, four males) included, 14 had secondary upper-limb lymphoedema after breast-cancer treatment and seven had secondary and five primary lower-limb lymphoedema. Median (interquartile range, IQR) ages at primary lower-limb lymphoedema and secondary lymphoedema onset were 18.5 (13–30) and 47.4 (35–58) years, respectively. Median body mass index (BMI) was 25.9 (22.9–29.3) kg m−2. For all patients, median pre-surgery lymphoedema duration was 37 (24–90) months. Thirty-four ALNs were transplanted into the 26  patients, combined with liposuction in four lower-limb-lymphoedema patients. Ten (38%) patients developed 15 complications: six, chronic lymphoedema (four upper limb, two lower limb), defined as ≥2-cm difference versus the contralateral side, in the limb on the donor lymph-node-site territory, persisting for a median of 40 months post-ALNT; four, post-surgical lymphocoeles; one testicular hydrocoele requiring  surgery; and four with persistent donor-site pain. Median (IQR)pre- and post-surgical lymphoedema volumes, calculated using the formula for a truncated cone, were, respectively, 1023 (633–1375) ml (median: 3 (1–6) months) and 1058 (666–1506) ml (median: 40 (14–72) months; P = 0.73).

Conclusion

ALNT may engender severe, chronic complications, particularly persistent iatrogenic lymphoedema. Further investigations are required to evaluate and clearly determine its indications.

Keywords
* Complication; 
* Lymphoedema; 
* Autologous lymph-node transplantation; 
* Surgery

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