Passenger lymphocyte syndrome after ABO-mismatched kidney transplantation: A case report and literature review

Zhou, Dawei; Leung, Junto; Hu, Zhengbin; Ye, Shaojun; Ye, Qifa

doi:10.1016/j.trim.2022.101725

Cited by 2 publications

(4 citation statements)

References 18 publications

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“…On suspicion, it is important for the clinician to exhaust alternative aetiologies, including autoimmune haemolytic anaemia and delayed transfusion reactions. Although the disorder will most often be detected following the onset of down-trending haemoglobin and evidence of haemolysis, a gradual rise of indirect bilirubin may be the initial observation prior to other signs and symptoms 28. A significant acute haemolytic burden in the setting of passenger lymphocyte syndrome following transfusion of multiple blood products may produce symptoms of chills, dyspnoea, hypotension and tachycardia that mimic a transfusion reaction 23.…”

Section: Discussionmentioning

confidence: 99%

Passenger lymphocyte syndrome following minor ABO-mismatched liver transplantation

Mathavan,

Krekora,

Kleehammer

et al. 2024

BMJ Case Rep

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Passenger lymphocyte syndrome is an immunologic disorder observed in solid organ and haematopoietic stem cell transplantation in which B lymphocytes within a donor graft are transferred to the recipient and subsequently produce circulating antibodies against host red blood cell antigens. The syndrome is most likely to occur in minor ABO blood group mismatched or Rh incompatible transplantation. Although generally mild and self-limited, the resulting haemolytic burden has the potential to increase the risk of infection, graft failure and death. The phenomenon is observed in the transplantation of any solid organ with lymphoid tissue, including the liver. We present a structured case report of passenger lymphocyte syndrome following minor ABO-mismatched liver transplantation, which was initially complicated by blood loss anaemia early in the postoperative period. By reviewing the limited literature of this disorder following liver transplantation, we emphasise common clinical findings and treatment strategies as well as introduce chimerism analysis to confirm resolution.

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Section: Discussionmentioning

confidence: 99%

Passenger lymphocyte syndrome following minor ABO-mismatched liver transplantation

Mathavan,

Krekora,

Kleehammer

et al. 2024

BMJ Case Rep

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“…In BMT, host lymphocytes are transferred into the recipient from the bone marrow or stem cell material obtained from the donor [17,25,112,113]. In solid organ transplantation, donor lymphocytes can be "passengers" in the solid organ obtained from the donor, and these can be transferred into the recipient [114][115][116][117][118]. It is feasible for donor lymphocytes that have been transferred to produce antibodies that are specific to RBC antigens in the recipient's body but not present on the donor's own red cells [17,25,[112][113][114][115][116][117][118].…”

Section: Passenger Lymphocyte Syndromementioning

confidence: 99%

“…In solid organ transplantation, donor lymphocytes can be "passengers" in the solid organ obtained from the donor, and these can be transferred into the recipient [114][115][116][117][118]. It is feasible for donor lymphocytes that have been transferred to produce antibodies that are specific to RBC antigens in the recipient's body but not present on the donor's own red cells [17,25,[112][113][114][115][116][117][118]. Indeed, sometimes these passenger lymphocytes in either BMT or solid organ transplants are obtained from donors who have been sensitized to produce alloantibodies to antigens for which they lack.…”

Section: Passenger Lymphocyte Syndromementioning

confidence: 99%

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Autoimmune Hemolytic Anemias: Classifications, Pathophysiology, Diagnoses and Management

Loriamini,

Cserti-Gazdewich,

Branch

2024

IJMS

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: Autoimmune hemolytic anemias (AIHAs) are conditions involving the production of antibodies against one’s own red blood cells (RBCs). These can be primary with unknown cause or secondary (by association with diseases or infections). There are several different categories of AIHAs recognized according to their features in the direct antiglobulin test (DAT). (1) Warm-antibody AIHA (wAIHA) exhibits a pan-reactive IgG autoantibody recognizing a portion of band 3 (wherein the DAT may be positive with IgG, C3d or both). Treatment involves glucocorticoids and steroid-sparing agents and may consider IVIG or monoclonal antibodies to CD20, CD38 or C1q. (2) Cold-antibody AIHA due to IgMs range from cold agglutinin syndrome (CAS) to cold agglutin disease (CAD). These are typically specific to the Ii blood group system, with the former (CAS) being polyclonal and the latter (CAD) being a more severe and monoclonal entity. The DAT in either case is positive only with C3d. Foundationally, the patient is kept warm, though treatment for significant complement-related outcomes may, therefore, capitalize on monoclonal options against C1q or C5. (3) Mixed AIHA, also called combined cold and warm AIHA, has a DAT positive for both IgG and C3d, with treatment approaches inclusive of those appropriate for wAIHA and cold AIHA. (4) Paroxysmal cold hemoglobinuria (PCH), also termed Donath–Landsteiner test-positive AIHA, has a DAT positive only for C3d, driven upstream by a biphasic cold-reactive IgG antibody recruiting complement. Although usually self-remitting, management may consider monoclonal antibodies to C1q or C5. (5) Direct antiglobulin test-negative AIHA (DAT-neg AIHA), due to IgG antibody below detection thresholds in the DAT, or by non-detected IgM or IgA antibodies, is managed as wAIHA. (6) Drug-induced immune hemolytic anemia (DIIHA) appears as wAIHA with DAT IgG and/or C3d. Some cases may resolve after ceasing the instigating drug. (7) Passenger lymphocyte syndrome, found after transplantation, is caused by B-cells transferred from an antigen-negative donor whose antibodies react with a recipient who produces antigen-positive RBCs. This comprehensive review will discuss in detail each of these AIHAs and provide information on diagnosis, pathophysiology and treatment modalities.

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Passenger lymphocyte syndrome after ABO-mismatched kidney transplantation: A case report and literature review

Cited by 2 publications

References 18 publications

Passenger lymphocyte syndrome following minor ABO-mismatched liver transplantation

Passenger lymphocyte syndrome following minor ABO-mismatched liver transplantation

Autoimmune Hemolytic Anemias: Classifications, Pathophysiology, Diagnoses and Management

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