Lymphaticovenular Anastomosis for Treatment of Lymphedema Developed After Liver Transplantation: A Case Report

Objective: Secondary lymphedema of the extremities usually develops well after lymph node dissection or radiation therapy in oncologic surgery. In this report, we present a case of lymphedema developed after liver transplantation and treatment by lymphaticovenular anastomosis (LVA). Methods: A 52-year-old man was diagnosed with hepatocellular carcinoma in April 2016, and a liver transplantation was performed in June 2016. After the liver transplantation, left lower leg swelling developed, and the symptom became severe for around a year. Two years after liver transplantation, lymphoscintigraphy and indocyanine green lymphography were performed, and the patient was diagnosed with lymphedema caused by proximal lymphatic obstruction. LVA was performed at the ankle and superior knee areas. Results: The difference between the left and right knee circumference was decreased from 5.3 cm to 3.4 cm at 6 months postoperatively. The lower extremity lymphedema index of the left leg was decreased from 291.9 to 288.1 at 6 months after surgery. A quality of life measure for limb lymphoedema survey showed that all 4 categories (function, appearance, symptoms, and mood) were improved at 6 months after surgery. Conclusion: Lymphedema can develop after liver transplantation, and early LVA surgery can be effective for the treatment of lymphedema developed after liver transplantation.