Acute intrahepatic lymphangiectasia following liver transplantation: An underrecognized potential etiology for biliary and portal vein stenosis.

Acute intrahepatic lymphangiectasia (IHL) is a pathologic condition characterized by abnormal dilation of the intrahepatic lymphatic vessels and related lymphedema, often resulting from impaired lymphatic drainage. Iatrogenic/non-iatrogenic abdominal injury and hepatic malignant neoplasms are the most common etiology of IHL. It is relatively common following liver transplantation, typically due to surgical manipulation or transient obstruction. In most cases, it is self-limiting and asymptomatic, requiring no specific intervention. To date, there have been no reports of IHL causing severe complications graded Clavien-Dindo III or higher. We report a case of acute IHL following liver transplantation that induced biliary and portal vein stenosis in the graft liver. This 51-year-old male patient with hepatitis B virus-related hepatocellular carcinoma developed acute IHL in the early posttransplant period, presenting with elevated alanine aminotransferase and bilirubin, diagnosed through imaging findings and cyst fluid analysis. Interventions included cyst aspiration, endoscopic biliary stenting, and percutaneous portal vein stenting due to biliary obstruction and portal vein stenosis. Liver function normalized, leading to discharge on postoperative day 60. At 5-month follow-up, imaging confirmed restored vascular and biliary patency, with sustained normal function over 8 months.