Lymphedema after solid organ transplantation is rare but may become clinically significant under immunosuppressive therapy. We report the case of a 56-year-old woman who developed bilateral lower-extremity lymphedema (LEL) after heart transplantation for idiopathic dilated cardiomyopathy. The patient was maintained on prednisolone, tacrolimus, and everolimus. Despite compression therapy and lymphatic drainage, the edema progressed. Preoperative assessment showed LEL indices of 287.8 (left) and 238.6 (right) . Lymphoscintigraphy demonstrated dermal backflow patterns in both lower legs, while lymphatic flow to the venous angle was preserved, excluding central obstruction. Under general anesthesia, lymphaticovenous anastomosis (LVA) was performed, with five anastomoses on the left and two on the right. The patient was discharged without complications. At 12 months, the LEL indices improved to 247.8 (left) and 230.4 (right) , with a marked reduction in dermal backflow. Cardiac function remained stable. This case represents the first report demonstrating both clinical and imaging improvement of post-heart transplant lymphedema following LVA. Careful preoperative imaging to guide surgical planning and long-term follow-up are essential to achieving and maintaining favorable outcomes.
