Wu TW, Hou TY, Yang JCS, Wang CC. First report of successful liver transplantation following supermicrosurgical lymphaticovenous anastomoses for lymphorrhea with intractable infection: A case report. World J Transplant 2025; 15(3): 101496 [DOI: 10.5500/wjt.v15.i3.101496]
Corresponding Author of This Article
Teng-Yuan Hou, MD, Doctor, Surgeon, Liver Transplantation Center and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-song, Kaohsiung 833401, Taiwan. vantone9187@gmail.com
Research Domain of This Article
Transplantation
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Transplant. Sep 18, 2025; 15(3): 101496 Published online Sep 18, 2025. doi: 10.5500/wjt.v15.i3.101496
First report of successful liver transplantation following supermicrosurgical lymphaticovenous anastomoses for lymphorrhea with intractable infection: A case report
Tse-Wei Wu, Teng-Yuan Hou, Johnson Chia-Shen Yang, Chih-Chi Wang
Tse-Wei Wu, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833401, Taiwan
Teng-Yuan Hou, Chih-Chi Wang, Liver Transplantation Center and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833401, Taiwan
Johnson Chia-Shen Yang, Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833401, Taiwan
Author contributions: Wang CC and Yang JSC were responsible for conceptualization, design of the study, and supervision; Hou TY was responsible for review and editing; Wu TW was responsible for drafting and revision of the article; all authors read and approved the final manuscript.
Informed consent statement: All study participants, or their legal guardians, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors of this manuscript have no conflicts of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Teng-Yuan Hou, MD, Doctor, Surgeon, Liver Transplantation Center and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-song, Kaohsiung 833401, Taiwan. vantone9187@gmail.com
Received: September 16, 2024 Revised: December 30, 2024 Accepted: February 6, 2025 Published online: September 18, 2025 Processing time: 213 Days and 15.4 Hours
Abstract
BACKGROUND
Liver transplant (LT) candidates face a heightened risk of infection both pre- and post-transplant, owing to immunosuppressive therapy and complications from chronic liver disease. Infections during the pre-transplant period, such as lymphorrhea-induced cellulitis, can cause significant delays in transplantation and increase mortality while on the waiting list. Lymphorrhea, characterized by substantial lymphatic leakage and recurrent skin infections, presents a significant challenge in managing patients who are already immunocompromised. Effective preoperative infection control is critical to enhancing the prospects for a successful liver transplantation.
CASE SUMMARY
We report the case of a 50-year-old female diagnosed with Hepatitis C virus-related cirrhosis (Child-Pugh C) and recurrent cellulitis due to lymphorrhea in her left lower leg. She suffered repeated episodes of cellulitis over five years, which prevented her from undergoing LT. Initial conservative treatments were unsuccessful in managing the lymphatic leakage and accompanying infections. In February 2019, she underwent supermicrosurgical lymphaticovenous anastomoses (LVA) to address her lymphorrhea. This procedure, which created multiple lymphatic-venous connections in the lower limb, led to significant improvements in her condition. After the LVA, she experienced no further episodes of cellulitis. Eighteen months later, she successfully underwent a deceased donor liver transplantation. Postoperative complications, including a wound hematoma, were effectively managed, and she was discharged 3 months post-operation. At her 3-year follow-up, her liver function was stable, with no recurrence of cellulitis.
CONCLUSION
Despite numerous challenges, the patient achieved a successful recovery with satisfactory graft function and was free from lymphorrhea/lymphedema in her left lower limb 3 years post-transplantation. This case underscores the importance of robust infection control during both the pre- and post-transplantation phases and highlights the potential of LVA as a treatment option for managing lymphorrhea and infections in patients with liver cirrhosis.
Core Tip: Lymphorrhea, characterized by significant lymphatic leakage, frequently leads to repeated skin infections that can preclude liver transplantation and increase the risk of dropping out of the waiting list. We present the case of a 50-year-old female patient with Hepatitis C virus-related liver cirrhosis and left lower leg lymphorrhea, which caused repeated episodes of cellulitis. This condition was successfully treated with supermicrosurgical lymphaticovenous anastomoses (LVA), followed by a deceased-donor liver transplantation. This case underscores the importance of stringent infection control both before and after transplantation and highlights LVA as a viable treatment option for managing lymphorrhea and infections in patients with liver cirrhosis.
