Introduction: There have been no published reports looking at the incidence of chyle leaks (chylous ascites or chylothorax) in adult patients following Intestinal or Multivisceral transplant. Use of an Medium Chain Triglyceride (MCT) enriched feed is proposed to prevent the development of chlye leaks following non-transplant abdominal or thoracic surgery. We reviewed the incidence of chyle leak in the post-operative period in a cohort of patients transplanted at Addenbrooke’s Hospital, Cambridge, UK.

Methods: A retrospective search of patient notes, radiology reports and biochemical analysis of post operative fluid collections was carried out on all patients who underwent Intestinal and Multivisceral Transplant between January 2006 and September 2016. Chylous fluid was defined by the physical appearance of fluid and in some case by measured triglycerides (110mg/dL).

Results: During this period a total of 71 transplants were performed on 65 patients. 17 transplants (24%) developed either chylous ascites or chylothorax following transplant. Three of these patients developed both chylous ascites and chylothorax, while 3 patients developed only a chylothorax and 11 developed only chylous ascites. Ten patients had chylous fluid confirmed biochemically. The mean length of time to diagnosis of Chylous fluid post transplantation was 30 days, with a range of 4 to 63 days. Initial enteral feeding was with a MCT-rich lipid source in 2/3 of patients, or a completely fat-free feed in 1/3. Despite this, rates of development of chyle leaks were relatively high in both groups (23% and 22% respectively).

Conclusion: The development of chylous ascites is related to the disruption of the lymphatic system at the time of surgery. ^[1]After transplant, patients receive parenteral nutrition until the transplanted graft begins to function. After this oral intake is permitted and feeding commences via a jejunostomy, if one has been placed during surgery. MCTs are not absorbed by the lymphatics therefore use of a MCT-rich enteral feed has been successful in other scenarios. However, a significant number of our patients developed chlye leaks despite this approach. A change in practice to a fully fat-free feed did not reduce the incidence, but patients were also allowed to eat during this time, which may account for these findings.   

[1] Cardenas A, Chorpa S. Chylous ascites. American Journal of Gastroenterology 2002;97:1896-900