Passenger lymphocyte syndrome in liver transplantation

Brunetta, Denise Menezes; Albuquerque, Lilian M. de; Batista, Andressa Hellen de Morais; Santos, Lhais Helenne O.; Schreen, Dirk; Lima, Clébia Azevedo de; Mesquita, D.F.G.; Carlos, Luciana Maria de Barros; Garcia, José Huygens Parente

doi:10.1016/j.bjhh.2017.07.006

Cited by 17 publications

(28 citation statements)

References 26 publications

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“…The immune hemolytic anemia, which occurred in our patient, was related to the blood-group compatible but non-identical LT, suggesting a transfer of functionally active donor B cells, also known as PLS [3]. PLS is a type of graft-versus-host disease, where donor immunocompetent memory B lymphocytes escape from immune surveillance of the immunosuppressed recipient and are stimulated to produce antibodies against red blood cell antigens, causing hemolysis.…”

Section: Introductionmentioning

confidence: 71%

“…The direct antiglobulin test became strongly positive for IgG and C3d and serum, and eluate prepared from red blood cells showed the presence of anti-A antibodies ( Table 1). Passenger lymphocyte syndrome (PLS) with immune hemolysis was diagnosed [3]. The nadir hemoglobin level was 7.2 g/dL on post-operative day 11, and 6 red blood cell units (O Rh+) were transfused between post-LT days 10 and 14 to maintain a hemoglobin level around 9.0 g/dL.…”

Section: Introductionmentioning

confidence: 99%

“…Management strategies for PLS are anecdotal and are described only in single case reports and small series [3,4,[8][9][10]. Therapeutic interventions include blood cell transfusion with donor compatible units during surgery and after LT, use of corticosteroids, plasmapheresis or red cell exchange, intravenous immunoglobulins, monoclonal antibodies, such as rituximab, or even splenectomy [3,4,[8][9][10].…”

Section: Introductionmentioning

confidence: 99%

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Severe Passenger Lymphocyte Syndrome and Acute Rejection in ABO Compatible but non-Identical Liver Transplant Recipient from Hepatitis C Viremic Donor

Martini¹,

David²,

Tandoi³

et al. 2018

obm transplant

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Background: We performed a liver transplant (LT) with a graft from a 52-year-old donor of blood group O who was HCV viremic. The recipient was a 52-year-old male with blood group A, HCV-related cirrhosis and hepatocellular carcinoma. Methods: A liver biopsy performed on post-LT day 9 revealed acute T-cell-mediated rejection and the patient received three 1.0-g boluses of methylprednisolone. On day 9, the hemoglobin level dropped and the direct antiglobulin test became positive. Passenger

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Section: Introductionmentioning

confidence: 71%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Severe Passenger Lymphocyte Syndrome and Acute Rejection in ABO Compatible but non-Identical Liver Transplant Recipient from Hepatitis C Viremic Donor

Martini¹,

David²,

Tandoi³

et al. 2018

obm transplant

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“…PLS is primarily due to the production of IgG antibodies (anti-A and anti-B) by donor B lymphocytes against recipient's red cell antigens. PLS can also be due to anti-D;[ 2 ] isolated cases of anti-c, anti-e, anti-Kell, anti-Jk a , or anti-Fy a have been reported. [ 5 ]…”

Section: Discussionmentioning

confidence: 99%

“…[ 1 ] Passenger lymphocyte syndrome (PLS) is due to the production of antibodies by the viable donor B “passenger” lymphocytes that is transferred at the time of organ transplantation against the recipient's red blood cell antigens. [ 2 ] In general, PLS is a self-limiting condition; nevertheless, cases of multiorgan failure and death have been reported. [ 3 ]…”

Section: Introductionmentioning

confidence: 99%

Passenger lymphocyte syndrome in a bidirectional ABO-mismatched renal transplant

Prethika

Shastry

Mohan

et al. 2020

Asian J Transfus Sci

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Passenger lymphocyte syndrome (PLS), a subtype of graft-versus-host disease, is due to the production of antibodies by the donor “passenger” B lymphocytes against recipient's red cells. It is a rare disorder encountered mostly in ABO blood group-mismatched solid organ transplantation. The present case report illustrates the clinical presentation and the mode of management of PLS in a bidirectional ABO-incompatible renal transplantation. A 43-year-old male diagnosed with chronic kidney disease Stage 5-D (diabetic nephropathy) Type-2 hypertension with ischemic heart disease underwent ABO bidirectional-mismatched renal transplantation. The blood group of the patient was B Rh D positive and that of the donor (patient's wife) was A Rh D positive. In the pretransplantation phase, immunoglobulin G anti-A titer was 64 by column agglutination method, which was subsequently brought down to 4 by therapeutic plasma exchange and immunosuppression. Good graft function was established in the posttransplantation phase, but a significant drop in the hemoglobin (Hb) was noted. A fall in Hb, peripheral smear findings suggestive of hemolysis, and direct antiglobulin test positivity along with raised lactate dehydrogenase suggested the diagnosis of PLS; the patient was managed successfully for the same by transfusion of O blood group packed red blood cell transfusion and immunosuppression. PLS is a rare but important cause of immune-mediated hemolytic anemia in ABO-mismatched transplants.

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