Conservative therapy, which approach is the best in the nutritional management of Chylous effusion following open donor nephrectomy: Case report

Conservative therapy, which approach is the best in the nutritional management of Chylous effusion following open donor nephrectomy: Case report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Conservative therapy, which approach is the best in the nutritional management of Chylous effusion following open donor nephrectomy: Case report Hakima Belhaoues, abdelmadjid guendouzi, Boucherit Benarab, Yasmina Rafaelle This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6521133/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Postoperative chyle leak after open donor nephrectomy is rare, but morbid complication that can compromise the safety of the donors. Treatment options can be challenging in the absence of clear guidelines due to relatively small number of studies .We are reporting here the first case in the literature of chylous effusion after an open donor nephrectomy when all reported cases were typically presented as chylous ascites.Our patient presented chyle effusion on the third day post nephrectomy.Diagnosis was confirmed by paracentesis. The patient was placed in a fasting state and received total parenteral nutrition with octreotide for three days. However, two episodes of hypoglycemia were noted. Consequently, we decided to initiate enteral feeding with a low-fat diet supplemented with medium-chain triglycerides which resulted in favorable progress over 10 days.Since there are no official guidelines, our case proposes a specific algorithm for the nutritional management of chyle effusion following open donor nephrectomy. Nutrition & Dietetics Gastroenterology & Hepatology Physiology Urology & Nephrology conservative therapy dietary modifications medium-chain triglycerides somatostatin analogs Figures Figure 1 Figure 2 1. Introduction Postoperative chyle leak after open donor nephrectomy, though uncommon, still occur and poses a potentially serious complication due to various consequences such as malnutrition and electrolyte imbalance ( 1 ). To the best of our knowledge we are reporting here the first case of chyle effusion after open living donor nephrectomy in literature because all reported cases were typically presented as chylous ascites. In The absence of clear guidelines,our report proposes a specific algorithm for the conservative approach. Case report : Our patient is a 40-year-old man with no prior medical or surgical history who was evaluated as a potential kidney donor for his 20-year-old son diagnosed with end-stage kidney disease. The nephrectomy was performed using an open procedure, No lymphatic effusion was noted intraoperatively and a drain was inserted in the renal fossa. The donor's postoperative course was unremarkable for the first 48 hours while he remained in a fasting state. On the third day, he began oral intake with a regular diet. By the fourth day, the amount of retroperitoneal drainage started to increase (220 mL/day) (Fig. 1 ), and the serous aspect became turbid, suggesting chyle leak, confirmed by paracentesis.The patient was initially managed with total parenteral nutrition (TPN) along with octreotide (0.1 mg three times a day) for 72 hours, resulting in a decrease in drainage amount (35 mL/day).However; two episodes of hypoglycemia were noted. Consequently, we decided to implement enteral feeding with a low-fat diet supplemented with medium-chain triglycerides (MCTs) and protein. The drainage amount remained less than 10 mL/day by the eighth day, and the drain was subsequently removed on the tenth postoperative day. He was discharged and continued on a low fat, high-protein, and MCTs diet for three months. During follow-up, no abdominal distension was observed, and the patient tolerated a regular diet thereafter. 2. Discussion The incidence of chylous ascites following donor nephrectomy is relatively low ( 2 ), with 54 documented cases to date ( 3 ). Three cases were reported as associated with open donor nephrectomy ( 2 )(Table 1 ), while the remaining cases occurred with laparoscopic donor nephrectomy. Table 1 Summary of literature review of chylous leakage after open donor nephrectomy for adult patient Author Year published Number of cases Age Gender Approach Tran Quoc Hoa et al 2023 1 45 Male Open donor nephrectomy Sandeep Harkaret al 2012 2 33 42 Female Female Open donor nephrectomy Conservative approaches should be tried as first line therapy for 6 to 12 weeks before proceeding to the surgical interventions ( 4 ).Patients are often placed on a high-protein and MCTs diet with restriction of long-chain triglycerides (LCTs) to reduce chyle production and allow the leak to close on its own ( 5 ). In cases where oral intake is insufficient, TPN may be used to provide necessary nutrition while allowing the digestive system to rest. Some authors describe it as first line of treatment regardless of leakage amount,while the others suggest it for patients with higher chyle leak outflow( 6 ).Octreotide can be associated with TPN; it inhibits the secretion of various hormones and delays the absorption of glucose and amino acids. By decreasing gastrointestinal motility, it may help reduce chyle flow. An enteral MCT-protein-rich diet with persistent retroperitoneal drainage can be recommended as an alternative with promising effects for our patient. According to approches that have been proposed in the literature, Fig. 2 shows our algorithm to resolve chyle effusion in a specific order based on drain output and the general condition of the patient. For that, patients have been divided in two groups: low and medium chyle leak ( 500 ml/day).Fasting with TPN can be the first choice for patients with low leak, if the chyle leak is not stopped after 7 days, octreotide can be used. In patients with medium volume chyle loss, octreotide with TPN seem more effective than TPN alone ( 7 ). If chylous effusion continues after 5 days, surgical approach should be considered. In cases with large volume of chyle leak, we can start immediately with TPN + octreotide with close monitoring. The described algorithm has been tested with our patient with favorable progress over 10 days. 3. Conclusion Chylous leakage is a critical condition that necessitates a collaborative approach.Our algorithm emphasizes the effectiveness of conservative therapy. However, the absence of clear guidelines underscores the importance of sharing case reports to establish an official algorithm for the management. Declarations Availability of data and material Not applicable Code availability Not applicable Authors’ contributions: HAKIMA BELHAOUES : Conceptualization, Investigation, planning of the work leading to the report, Writing–original draft, review and editing; GUENDOUZI ABDELMADJID critically revising and adding important intellectual content YASMINA RAFAELLE BOUCHERIT BENARAB : critical evaluation of the manuscript, supervision All authors have read and agreed to the published version of the manuscript Funding No funds, grants, or other support was received. Ethics approval The ethical approval was reviewed by the president of the scientific Council of the institution and the authors conducted the study in absolute respect of the ethical principles related to confidentiality, consent, non maleficence and justice in accordance with the Helsinki Declaration of the world medical association. Written Consent for publication Written informed consent for publication has been given by the patient Information revealing the patient’s identity has been avoided. Competing interests The authors have no relevant financial or non-financial interests to disclose References LEIBOVITCH I, MOR Y, GOLOMB J, RAMON J. THE DIAGNOSIS (2002) AND MANAGEMENT OF POSTOPERATIVE CHYLOUS ASCITES. J Urol 167:449–457 Janki S, Terkivatan T, Kimenai HJAN, IJzermans JNM, Tran TCK (2016) First case report of chylous ascites after robot-assisted donor nephrectomy. J Surg Case Rep ;2016 Hiffa A, Schulte K, Saeed M, Gani I (2022) Massive Chylous Ascites After Living Donor Nephrectomy Successfully Treated With Lymphatic Embolization. J Investig Med High Impact Case Rep 10:23247096211065631 Kim BS, Kwon TG (2016) Chylous ascites in laparoscopic renal surgery: Where do we stand? World J Clin Urol 5:37–44 Bhardwaj R, Vaziri H, Gautam A, Ballesteros E, Karimeddini D, Wu GY (2018) Chylous Ascites: A Review of Pathogenesis, Diagnosis and Treatment. J Clin Translational Hepatol 6:105–111 Delaney SW, Shi H, Shokrani A, Sinha UK (2017) Management of chyle leak after head and neck surgery: review of current treatment strategies. Int J Otolaryngol 2017:8362874 Kobayashi M, Kambara T, Kamai T (2015) A Rare Complication of Chylous Leakage After Open Partial Nephrectomy Successfully Resolved by Somatostatin Analogue. Urol Case Rep 3:195–197 Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6521133","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":447504923,"identity":"d47ca0fe-edc6-4c1d-a2d2-d366ca17ac84","order_by":0,"name":"Hakima Belhaoues","email":"data:image/png;base64,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","orcid":"https://orcid.org/0009-0002-7551-3399","institution":"Faculty of Medicine Badji Mokhtar University","correspondingAuthor":true,"prefix":"","firstName":"Hakima","middleName":"","lastName":"Belhaoues","suffix":""},{"id":447504924,"identity":"29779732-a7d8-4c96-a2b4-507127911fca","order_by":1,"name":"abdelmadjid guendouzi","email":"","orcid":"","institution":"cPharmaceutical Sciences Research CRSP, ZAM Ali Mendjeli, Constantine, Algeria","correspondingAuthor":false,"prefix":"","firstName":"abdelmadjid","middleName":"","lastName":"guendouzi","suffix":""},{"id":447504925,"identity":"e6ae3c2e-e9ce-4d8f-b97a-ea8efc31060d","order_by":2,"name":"Boucherit Benarab, Yasmina Rafaelle","email":"","orcid":"","institution":"aculty of Medicine Badji Mokhtar University","correspondingAuthor":false,"prefix":"","firstName":"Yasmina","middleName":"Rafaelle Boucherit","lastName":"Benarab","suffix":""}],"badges":[],"createdAt":"2025-04-24 13:17:42","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-6521133/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6521133/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":81963623,"identity":"1d093cfd-020d-4f04-a6ec-462df6485cb9","added_by":"auto","created_at":"2025-05-05 11:21:26","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":13704,"visible":true,"origin":"","legend":"\u003cp\u003eDaily postoperative drain output\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6521133/v1/5637c91c5d096c30ac14141b.png"},{"id":81962657,"identity":"fc50d01e-4e79-435f-a36f-d8427c18ea6b","added_by":"auto","created_at":"2025-05-05 11:13:26","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":32978,"visible":true,"origin":"","legend":"\u003cp\u003eOur algorithm for conservative therapy in chyle effusion\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6521133/v1/44315aca6723bd6e106a804f.png"},{"id":81965393,"identity":"504e3a06-1cde-4f1c-90d1-4160dc3d9fa2","added_by":"auto","created_at":"2025-05-05 11:29:30","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":416018,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6521133/v1/b168ca3f-b0b8-464e-a3e7-67aa87bb0be4.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003eConservative therapy, which approach is the best in the nutritional management of Chylous effusion following open donor nephrectomy: Case report\u003c/p\u003e","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003ePostoperative chyle leak after open donor nephrectomy, though uncommon, still occur and poses a potentially serious complication due to various consequences such as malnutrition and electrolyte imbalance (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). To the best of our knowledge we are reporting here the first case of chyle effusion after open living donor nephrectomy in literature because all reported cases were typically presented as chylous ascites. In The absence of clear guidelines,our report proposes a specific algorithm for the conservative approach.\u003c/p\u003e \u003cp\u003e \u003cb\u003eCase report\u003c/b\u003e:\u003c/p\u003e \u003cp\u003eOur patient is a 40-year-old man with no prior medical or surgical history who was evaluated as a potential kidney donor for his 20-year-old son diagnosed with end-stage kidney disease. The nephrectomy was performed using an open procedure, No lymphatic effusion was noted intraoperatively and a drain was inserted in the renal fossa. The donor's postoperative course was unremarkable for the first 48 hours while he remained in a fasting state.\u003c/p\u003e \u003cp\u003eOn the third day, he began oral intake with a regular diet. By the fourth day, the amount of retroperitoneal drainage started to increase (220 mL/day) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), and the serous aspect became turbid, suggesting chyle leak, confirmed by paracentesis.The patient was initially managed with total parenteral nutrition (TPN) along with octreotide (0.1 mg three times a day) for 72 hours, resulting in a decrease in drainage amount (35 mL/day).However; two episodes of hypoglycemia were noted. Consequently, we decided to implement enteral feeding with a low-fat diet supplemented with medium-chain triglycerides (MCTs) and protein.\u003c/p\u003e \u003cp\u003eThe drainage amount remained less than 10 mL/day by the eighth day, and the drain was subsequently removed on the tenth postoperative day. He was discharged and continued on a low fat, high-protein, and MCTs diet for three months. During follow-up, no abdominal distension was observed, and the patient tolerated a regular diet thereafter.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"2. Discussion","content":"\u003cp\u003eThe incidence of chylous ascites following donor nephrectomy is relatively low (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e), with 54 documented cases to date (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Three cases were reported as associated with open donor nephrectomy (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)(Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), while the remaining cases occurred with laparoscopic donor nephrectomy.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSummary of literature review of chylous leakage after open donor nephrectomy for adult patient\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAuthor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYear published\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNumber of cases\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eApproach\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTran Quoc Hoa et al\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOpen donor nephrectomy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSandeep Harkaret al\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e33\u003c/p\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOpen donor nephrectomy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eConservative approaches should be tried as first line therapy for 6 to 12 weeks before proceeding to the surgical interventions (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).Patients are often placed on a high-protein and MCTs diet with restriction of long-chain triglycerides (LCTs) to reduce chyle production and allow the leak to close on its own (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn cases where oral intake is insufficient, TPN may be used to provide necessary nutrition while allowing the digestive system to rest. Some authors describe it as first line of treatment regardless of leakage amount,while the others suggest it for patients with higher chyle leak outflow(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).Octreotide can be associated with TPN; it inhibits the secretion of various hormones and delays the absorption of glucose and amino acids. By decreasing gastrointestinal motility, it may help reduce chyle flow. An enteral MCT-protein-rich diet with persistent retroperitoneal drainage can be recommended as an alternative with promising effects for our patient. According to approches that have been proposed in the literature, Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows our algorithm to resolve chyle effusion in a specific order based on drain output and the general condition of the patient. For that, patients have been divided in two groups: low and medium chyle leak (\u0026lt;\u0026thinsp;500ml/day) and high volume chyle (\u0026gt;\u0026thinsp;500 ml/day).Fasting with TPN can be the first choice for patients with low leak, if the chyle leak is not stopped after 7 days, octreotide can be used. In patients with medium volume chyle loss, octreotide with TPN seem more effective than TPN alone (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). If chylous effusion continues after 5 days, surgical approach should be considered. In cases with large volume of chyle leak, we can start immediately with TPN\u0026thinsp;+\u0026thinsp;octreotide with close monitoring. The described algorithm has been tested with our patient with favorable progress over 10 days.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"3. Conclusion","content":"\u003cp\u003eChylous leakage is a critical condition that necessitates a collaborative approach.Our algorithm emphasizes the effectiveness of conservative therapy. However, the absence of clear guidelines underscores the importance of sharing case reports to establish an official algorithm for the management.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAvailability of data and material\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCode availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHAKIMA BELHAOUES\u003c/strong\u003e: Conceptualization, Investigation,\u0026nbsp;planning of the work leading to the report, Writing\u0026ndash;original draft, review and editing;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGUENDOUZI ABDELMADJID\u0026nbsp;\u003c/strong\u003ecritically revising and adding important intellectual content\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eYASMINA RAFAELLE BOUCHERIT BENARAB\u003c/strong\u003e:\u0026nbsp;critical evaluation of the manuscript,\u0026nbsp;supervision\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll authors have read and agreed to the published version of the manuscript\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funds, grants, or other support was received.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe ethical approval was reviewed by the president of the scientific Council of the institution and the authors conducted the study in absolute respect of the ethical principles related to confidentiality, consent, non maleficence and justice in accordance with the Helsinki Declaration of the world medical association.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWritten Consent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent for publication has been given by the patient Information revealing the patient\u0026rsquo;s identity has been avoided.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no relevant financial or non-financial interests to disclose\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eLEIBOVITCH I, MOR Y, GOLOMB J, RAMON J. THE DIAGNOSIS (2002) AND MANAGEMENT OF POSTOPERATIVE CHYLOUS ASCITES. J Urol 167:449\u0026ndash;457\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJanki S, Terkivatan T, Kimenai HJAN, IJzermans JNM, Tran TCK (2016) First case report of chylous ascites after robot-assisted donor nephrectomy. J Surg Case Rep ;2016\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHiffa A, Schulte K, Saeed M, Gani I (2022) Massive Chylous Ascites After Living Donor Nephrectomy Successfully Treated With Lymphatic Embolization. J Investig Med High Impact Case Rep 10:23247096211065631\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim BS, Kwon TG (2016) Chylous ascites in laparoscopic renal surgery: Where do we stand? World J Clin Urol 5:37\u0026ndash;44\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBhardwaj R, Vaziri H, Gautam A, Ballesteros E, Karimeddini D, Wu GY (2018) Chylous Ascites: A Review of Pathogenesis, Diagnosis and Treatment. J Clin Translational Hepatol 6:105\u0026ndash;111\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDelaney SW, Shi H, Shokrani A, Sinha UK (2017) Management of chyle leak after head and neck surgery: review of current treatment strategies. Int J Otolaryngol 2017:8362874\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKobayashi M, Kambara T, Kamai T (2015) A Rare Complication of Chylous Leakage After Open Partial Nephrectomy Successfully Resolved by Somatostatin Analogue. Urol Case Rep 3:195\u0026ndash;197\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"conservative therapy, dietary modifications, medium-chain triglycerides, somatostatin analogs","lastPublishedDoi":"10.21203/rs.3.rs-6521133/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6521133/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003ePostoperative chyle leak after open donor nephrectomy is rare, but morbid complication that can compromise the safety of the donors. Treatment options can be challenging in the absence of clear guidelines due to relatively small number of studies .We are reporting here the first case in the literature of chylous effusion after an open donor nephrectomy when all reported cases were typically presented as chylous ascites.Our patient presented chyle effusion on the third day post nephrectomy.Diagnosis was confirmed by paracentesis. The patient was placed in a fasting state and received total parenteral nutrition with octreotide for three days. However, two episodes of hypoglycemia were noted. Consequently, we decided to initiate enteral feeding with a low-fat diet supplemented with medium-chain triglycerides which resulted in favorable progress over 10 days.Since there are no official guidelines, our case proposes a specific algorithm for the nutritional management of chyle effusion following open donor nephrectomy.\u003c/p\u003e","manuscriptTitle":"Conservative therapy, which approach is the best in the nutritional management of Chylous effusion following open donor nephrectomy: Case report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-05 11:13:21","doi":"10.21203/rs.3.rs-6521133/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"70117196-077f-4089-bcea-5db836527a85","owner":[],"postedDate":"May 5th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":47632701,"name":"Nutrition \u0026 Dietetics"},{"id":47632702,"name":"Gastroenterology \u0026 Hepatology"},{"id":47632703,"name":"Physiology"},{"id":47632704,"name":"Urology \u0026 Nephrology"}],"tags":[],"updatedAt":"2025-05-05T11:13:21+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-05 11:13:21","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6521133","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6521133","identity":"rs-6521133","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}