Passenger lymphocyte syndrome due to anti-D antibodies in liver transplantation. Case report
DOI:
https://doi.org/10.22516/25007440.814Keywords:
Direct Coombs Test, Hemolytic anemia, Liver transplantation, Case ReportAbstract
Passenger lymphocyte syndrome (PLS) is a graft-versus-host complication in solid organ transplantation or hematopoietic stem cell transplantation. It is a major cause of immune hemolysis after transplantation caused by the production of antibodies by the specific clones of viable B lymphocytes transferred through the donor organ against the antigens of the recipient’s red blood cells. It usually occurs in transplants with minor ABO or Rh mismatch. This descriptive study explains the case of a 54-year-old patient with O/Rh(D) positive blood group, with cirrhosis secondary to metabolic disease associated with fatty liver (NAFLD), who underwent liver transplantation from an O/Rh(D) negative donor. Nine days after the transplant, the patient presented with immune hemolytic anemia due to anti-D antibodies because of the transient B lymphocyte from the sensitized donor. The patient received support measures, transfusion of red blood cells, and immunosuppression with steroids, which stabilized the hemolytic parameters. In conclusion, this entity should be suspected in the case of acute hemolytic anemia in the post-transplant period.
Downloads
References
Jung J, Lee JM, Yang M, Choi SJ, Lim J. Transient loss of A1 phenotype in a patient with passenger lymphocyte syndrome after ABO minor incompatible liver transplantation: The first case report. Transfus Apher Sci. 2018;57(6):759-61. https://doi.org/10.1016/j.transci.2018.09.014
Neuberger J, Ferguson J, Newsome PN, Lucey MR. Liver Transplantation: Clinical Assessment and Management. Wiley; 2021. https://doi.org/10.1002/9781119634010
Gugenheim J, Samuel D, Bismuth H, Reynes M. Liver transplantation across ABO blood group barriers. Lancet. 1990;336(8714):519-23. https://doi.org/10.1016/0140-6736(90)92082-s
Brunetta DM, Albuquerque LM, Batista AHM, Santos LHO, Schreen D, Lima CA, et al. Passenger lymphocyte syndrome in liver transplantation. Rev Bras Hematol Hemoter. 2017;39(4):364-7. http://doi.org/10.1016/j.bjhh.2017.07.006
Yazer MH, Triulzi DJ. Immune hemolysis following ABO-mismatched stem cell or solid organ transplantation. Curr Opin Hematol. 2007;14(6):664-70. http://doi.org/10.1097/MOH.0b013e3282e9a576
Moosavi MM, Duncan A, Stowell SR, Roback JD, Sullivan HC. Passenger Lymphocyte Syndrome; a Review of the Diagnosis, Treatment, and Proposed Detection Protocol. Transfus Med Rev. 2020;34(3):178-87. https://doi.org/10.1016/j.tmrv.2020.06.004
Audet M, Panaro F, Piardi T, Huang P, Cag M, Cinqualbre J, et al. Passenger lymphocyte syndrome and liver transplantation. Clin Dev Immunol. 2008;2008:715769. https://doi.org/10.1155/2008/715769
Romero S, Solves P, Lancharro A, Cano I, Moscardó F, Carpio N, et al. Passenger lymphocyte syndrome in liver transplant recipients: A description of 12 cases. Blood Transfus. 2015;13(3):423-8. https://doi.org/10.2450/2015.0148-14
Maheshwari A, Mishra R, Thuluvath PJ. Post-liver-transplant anemia: Etiology and management. Liver Transplant. 2004;10(2):165-73. https://doi.org/10.1002/lt.20031
Smith EP. Hematologic Disorders after Solid Organ Transplantation. Hematology. 2010;2010(1):281-6. https://doi.org/10.1182/asheducation-2010.1.281
Jacobs J, Pogue E, Johnson M, Eichbaum Q. Passenger lymphocyte syndrome with severe haemolysis misdiagnosed/treated as cold agglutinin syndrome: Analysis of case and diagnostic error. Transfus Med. 2021;31(4):305-7. https://doi.org/10.1111/tme.12773
Ramsey G. Red cell antibodies arising from solid organ transplants. Transfusion. 1991;31(1):76-86. http://doi.org/10.1046/j.1537-2995.1991.31191096190.x
de Bruijn S, Philipse E, Couttenye MM, Bracke B, Ysebaert D, Michielsen P, et al. Passenger lymphocyte syndrome (PLS): A single-center retrospective analysis of minor ABO-incompatible liver transplants. J Clin Transl Hepatol. 2017;5(1):9-15. https://doi.org/10.14218/JCTH.2016.00072
Squires JE. Passenger lymphocyte syndrome: A case report involving non-ABO antibodies. Transfus Med Hemother. 2014;41(2):153-5. https://doi.org/10.1159/000357985
Nadarajah L, Ashman N, Thuraisingham R, Barber C, Allard S, Green L. Literature Review of Passenger Lymphocyte Syndrome Following Renal Transplantation and Two Case Reports. Am J Transplant. 2013;13(6):1594-600. https://doi.org/10.1111/ajt.12219
Brunetta DM, Barros Carlos LM, Da Silva VFP, Oliveira Alves TM, Macedo ÊS, Coelho GR, et al. Prospective evaluation of immune haemolysis in liver transplantation. Vox Sang. 2020;115(1):72-80. https://doi.org/10.1111/vox.12865
Monfort M, Honoré P, Gothot A, Gérard C. Simultaneous passenger lymphocyte syndrome and multiple alloimmunization against donor’s blood group antigens after liver transplantation. Vox Sang. 2015;109(1):86-90. https://doi.org/10.1111/vox.12253
Nguyen C, Fontaine M, Meier R, Jakhete N. Passenger Lymphocyte Syndrome: A Rare Case of Anemia After Liver Transplant. Exp Clin Transplant. 2022;20(2):222-3. https://doi.org/10.6002/ect.2021.0328
Peck JR, Elkhammas EA, Li F, Stanich PP, Latchana N, Black S, et al. Passenger lymphocyte syndrome: a forgotten cause of postliver transplant jaundice and anemia. Exp Clin Transplant. 2015;13(2):200-2. https://doi.org/10.6002/ect.2013.0239
Marton A, Pendergrast JM, Keshavjee S, Singer L, Hawes J, Cserti-Gazdewich C. Passenger Lymphocyte Syndrome Following Solid Organ Transplantation: Graft Source, Incidence, Specificity, Duration, and Severity Of Hemolysis. Blood. 2013;122(21):37. https://doi.org/10.1182/blood.V122.21.37.37
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Aquellos autores/as que tengan publicaciones con esta revista, aceptan los términos siguientes:
Los autores/as ceden sus derechos de autor y garantizarán a la revista el derecho de primera publicación de su obra, el cuál estará simultáneamente sujeto a la Licencia de reconocimiento de Creative Commons que permite a terceros compartir la obra siempre que se indique su autor y su primera publicación en esta revista.
Los contenidos están protegidos bajo una licencia de Creative Commons Reconocimiento-NoComercial-SinObraDerivada 4.0 Internacional.
| Article metrics | |
|---|---|
| Abstract views | |
| Galley vies | |
| PDF Views | |
| HTML views | |
| Other views | |
