Role of early povidone iodine instillation in post-renal transplant lymphorrhea: A prospective randomized studySureka, S. K., et al.
Turkish Journal of Urology 2019; 45(6): 461-466.
The primary objective of this study was to examine the role of early instillation of povidone iodine in the management of lymphorrhea in patients who have undergone renal transplantation.
Patients were randomized to receive either 0.5% povidone iodine instillation or no instillation.
124 renal transplant recipients.
The primary endpoint was the resolution of lymphorrhea. The secondary endpoints included the total cost of treatment, duration of hospital stay and the incidence of symptomatic and asymptomatic lymphocoeles.
This single-centre study investigates the role of poviodine iodine instillation through the drain as prophylaxis against lymphatic complications in renal transplant recipients with persistent drain output at day 5 post-op. The authors find that there is a reduction in duration of lymphorrhoea and development of symptomatic lymphocele with poviodine iodine instillation. Whilst very interesting, there are some methodological and clinical issues that may affect interpretation and generalisability. There is no published protocol or prospective trial registration. The study is not blinded, and no method of allocation concealment is described leading to a risk of selection bias. Patients in the study were recruited over a very long period of time (2002 to 2015), and very few baseline characteristics are given to check the efficacy of randomisation – in particular, there are no details on surgical technique (method of lymphatic dissection) or immunosuppression used. Duration of drainage and hospital stay was much longer than contemporary practice in most centres, and so these findings would require confirmation in other cohorts.