Role of Decongestive Therapy For Lymphedema In A Patient After Liver Transplantation: A Case Report

Öz

Lymphedema is defined as the abnormal accumulation of protein-rich fluid in the interstitial space as a result of deterioration in lymphatic system functions. In our case, we describe a patient that developed lymphedema symptoms in his right upper extremity following liver transplantation. After the lymphedema diagnosis, the patient underwent complex decongestive therapy, which included 30 sessions of manual lymphatic drainage (30 minutes a day) and 30 sessions of multilayer bandaging (five days a week). There was an improvement in both the shoulder joint range of motion and circumferences measurements of the hand and arm after treatment.Based on this case, we recommend manual lymph drainage as a preventative in the early period after organ transplants affecting the lymphatic system.

Anahtar Kelimeler

• Lymphedema
• transplantation
• liver lymph
• decongestive therapy

Karaciğer Nakli Sonrası Bir Hastada Lenfödem İçin Dekonjestif Tedavinin Rolü: Bir Olgu Sunumu

Öz

Lenfödem, lenfatik sistem fonksiyonlarındaki bozulma sonucu interstisyel boşlukta proteinden zengin sıvının anormal birikimi olarak tanımlanır. Olgumuzda karaciğer nakli sonrası sağ üst ekstremitede lenfödem semptomları gelişen bir hastayı tanımladık. Lenfödem tanısından sonra hastaya 30 seans manuel lenfatik drenaj (günde 30 dakika) ve 30 seans çok katmanlı bandaj (haftada beş gün) içeren dekonjestif tedavi uygulandı. Tedaviden sonra hem omuz eklemi hareket açıklığı hem de el ve kol çevre ölçümlerinde iyileşme oldu. Bu olgudan hareketle lenfatik sistemi etkileyen organ nakillerinden sonra erken dönemde koruyucu olarak manuel lenf drenajını öneriyoruz.

Anahtar Kelimeler

• Lenfödem
• transplantasyon
• karaciğer lenfi
• dekonjestif tedavi

Kaynakça

1. 1. Johnson KC, Kennedy AG and Henry SM. Clinical measurements of lymphedema. Lymphat. Res. Biol. 2014; 12: 216-21.
2. 2. Ohtani O and Ohtani Y. Lymph circulation in the liver. Anat. Rec 2008; 291: 643-52.
3. 3. Koslin D, Stanley R, Berland L, et al. Hepatic perivascular lymphedema: CT appearance. AJR 1988; 150: 111-3.
4. 4. Stamp GFW and Peters AM. Peripheral lymphovenous communication in lymphoedema. Nucl. Med. Commun. 2012; 33: 701-7.
5. 5. Deltombe T, Jamart J , Recloux S, et al. Reliability and limits of agreement of circumferential, water displacement, and optoelectronic volumetry in the measurement of upper limb lymphedema. Lymphology. 2007; 40: 26-34.
6. 6. Borman P, Yaman A, Denizli M, et al. The reliability and validity of Lymphedema Quality of Life Questionnaire-Arm in Turkish patients with upper limb lymphedema related with breast cancer. Turk J Physiother Rehabil. 2018; 64: 205-212.
7. 7. Sezgin Ozcan D, Dalyan M, Unsal Delialioglu S, et al. Complex decongestive therapy enhances upper limb functions in patients with breast cancer-related lymphedema. Lymphat. Res. Biol. 2018; 16: 446-52.
8. 8. Lasinski BB. Complete decongestive therapy for treatment of lymphedema. Semin. Oncol. Nurs. 2013; 29: 20-27.

9. 9. Saab S, Nguyen S, Collins J, et al. Lymphedema tarda after liver transplantation: a case report and review of the literature. ECT 2006; 4: 567-570.
10. 10. Motse KG and Mashabane MJ. Sirolimus-induced lymphoedema. S. Afr. Med. J. 2016; 106: 886-7.
11. 11. Ardalan M-R. Lymphedema attributed to sirolimus. J. Nephropharmacology 2013; 2: 35-36.
12. 12. Ersoy A and Koca N. Everolimus-induced lymphedema in a renal transplant recipient: a case report. Exp Clin Transplant. 2012; 10: 296-98.
13. 13. Kim S, Yi CH and Kwon O. Effect of complex decongestive therapy on edema and the quality of life in breast cancer patients with unilateral lymphedema. Lymphology. 2007; 40 : 143-51.
14. 14. Mondry TE, Riffenburgh RH and Johnstone PA. Prospective trial of complete decongestive therapy for upper extremity lymphedema after breast cancer therapy. Cancer J. 2004; 10: 42-48.