A 59-year-old woman complained of increasing pain in the left abdomen and of diarrheal symptoms after left-sided retroperitoneoscopic living donor nephrectomy. Computed tomography revealed chyloretroperitoneum. The fluid was drained percutaneously, followed by recurrent drain replacement surgery. Her diet was changed to short-chain and medium-chain fatty acids without success. After onset of dyspnea due to chylothorax, the donor underwent thoracic drainage, fully parenteral therapy, and finally somatostatin application therapy. The postoperative management of severe chylous fistula is difficult. Therefore, we recommend an early start of maximal conservative therapy. Surgical options depend on pain occurrence or mechanical problems.