Role of early povidone iodine instillation in post-renal transplant lymphorrhea: A prospective randomized study

Abstract

Objective: The aim of the present study was to prospectively evaluate the role of early povidone iodine instillation in the management of post-renal transplant lymphorrhea. Material and methods: Live-related renal transplant recipients operated between January 2002 and December 2015 were included in the study. Significant lymphorrhea was defined as >50 mL lymph from drain beyond postoperative day 5. Such patients were randomized into two groups by simple randomization using a computer-generated random list: group A (received 0.5% povidone iodine instillation) and group B (no instillation). Absolute risk reduction and numbers needed to treat were calculated to estimate the effect of povidone iodine instillation for the treatment of lymphorrhea and decrease in the incidence of lymphocoele. Results: A total of 1766 patients underwent renal transplant during this period. One hundred seventeen patients with lymphorrhea through the drain underwent randomization into group A (n=61) and group B (n=56). In group A, 58 patients had successful resolution within 2 weeks, whereas in group B, 34 patients had successful resolution within 2 weeks. Overall, 9 (14.75%) patients in group A and 29 (51.78%) patients in group B had lymphatic collections (both symptomatic and asymptomatic). Symptomatic lymphocoele was present in 1 patient in group A and 7 patients in group B on follow-up. Absolute risk reduction was 10.8%, and for every symptomatic lymphocoele prevented, 10 patients needed povidone iodine instillation. Conclusion: Povidone iodine instillation after 5 days of transplantation aids in the early resolution of post-renal transplantation lymphorrhea, as well as reduces the incidence of future lymphocoele.