Is Efficacy of the Anti‐Cd20 Antibody Rituximab Preventing Hemolysis Due to Passenger Lymphocyte Syndrome?

Abstract

Passenger lymphocyte syndrome (PLS) often occurs after ABO-mismatched solid organ and/or bone marrow transplantation between a donor and recipient. Viable donor B-lymphocytes transferred during organ transplantation produce antibodies against recipient red cell antigens, leading to hemolysis. The incidence of PLS has been reported to be around 9% after renal transplantation. A previous report showed that rituximab (Rit) was useful for treatment of PLS in allogeneic stem cell transplantation, bowel transplant and severe cases of hemolysis. However, the effectiveness of Rit in preventing PLS after renal transplantation has not yet been evaluated. The participants in this study were 85 patients who had undergone ABO-mismatched renal transplantation from January 2005 to April 2013. Rit was administered to these patients before transplantation. None of the patients that received Rit treatment developed PLS. Thus administration of Rit before transplantation effectively controlled the production of antibodies by B-lymphocytes, which probably prevented the development of PLS.

Low‐dose rituximab induction therapy is effective in immunological high‐risk renal transplantation without increasing cytomegalovirus infection

“…In our facility, we used Rit as induction therapy, not only for ABO major mismatch, but also for ABO minor mismatch, for the following reasons: (i) ABO minor mismatched renal transplantation is immunologically higher risk than ABO matched; 23 and (ii) to avoid passenger lymphocyte syndrome in ABO minor mismatched renal transplantation. 23 It is known that hemolytic anemia is sometimes caused because of graft versus host disease in the acute phase of ABO minor mismatched renal transplantation. [24][25][26] Renal graft irradiation can prevent hemolytic anemia, but there is a risk of secondary carcinogenesis by irradiation.…”

Passenger Lymphocyte Syndrome as a rare cause of hemolysis in a patient after small intestine transplantation, A case report and review of the literature

“…In the study, they used 200 mg of rituximab in the operation room as the induction immunosuppressive agent. [ 19 ] In a report of blood type A to B kidney transplantation, the patient received a single-dose of 200 mg/m 2 rituximab combined with sessions of plasmapheresis 2 weeks before the transplantation but eventually developed PLS; however, in this report, rituximab was administered 2 weeks earlier to the operation and sessions of plasmapheresis might have lowered the serum level of the drug resulting in minimal effect on donor passenger lymphocytes. [ 20 ] In the current report, our patient developed PLS despite receiving a total dose of 1000 mg rituximab (divided into two equal doses, infused in the operation room and on the 5 th POD.…”

Severe passenger lymphocyte syndrome associated to Rh antibodies after donor living renal transplantation

“…The patient was O Rh positive (ccDEe) and had negative indirect antiglobulin test (IAT) and negative direct antiglobulin test (DAT); Her HLA low resolution typing was: A (2, 32); B (65, 63); DR 1,13 . Her sister was O Rh positive; HLA low resolution typing: A (1, 32); B (8,14); DR (1,8). Complement dependent cytotoxicity (CDC) and flow cytometry cross match were negative, panel reactive antibody (PRA) was 0%.…”