Passenger lymphocyte syndrome exhibited in a renal transplant recipient: A case report

Chandra, Abhilash; Gupta, Shubha; Sharma, Raj Kumar; Kaul, Anupama; Bhadauria, Dharmendra; Prasad, Narayan; Gupta, Amit; Elhence, Preeti; Sonkar, Atul; Chandra, Hem

doi:10.1016/j.ijt.2012.08.003

Cited by 2 publications

(3 citation statements)

References 15 publications

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“…al., 2009, Petz, L. D., 2005, Ramsey, G., 1991. We found in the literature described with cases of hemolytic anemia mostly often developed after heart and lung transplantation (Chandra A. et. al., 2012, Ainsworth C. D., et.…”

Section: Discussionmentioning

confidence: 95%

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Hemolytic Crisis after AB0-Nonidentical Solid Transplantation: Case Report

Pashkova¹,

Гилевич²,

Porhanov³

2014

IMMU

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Passenger lymphocyte syndrome develops after non-identical solid transplantations and may cause acute hemolytic anemia. A standard treatment for such patients is not known. We have reported 2 cases of hemolytic anemia developed during the early postoperative period after liver transplantation and our therapeutic approach. Both patients showed AB Rh (D) positive blood type. The donors had B Rh (D) positive. Pretransplant HLA screening showed lack of antibodies. The first patient developed severe anemia on 16 posttransplantation day. The second patient was noticed with decreased hemoglobin and the increased of the liver enzymes on 5 day after transplantation. The liver biopsy of the second patient showed immunological damage features. In both cases anti-A1 antibodies were determined by indirect antiglobulin test (IAT) applying elution techniques, heat autocontrol was also positive. In all patients the direct antiglobulin test (DAT) was positive. The first patient was in stable conditions and did not demand any specific therapy. In the second case the pulse therapy with methylprednisolone (MP), and the plasmapheresis was initiated. Both patients were transfused with 0 RBC washed concentrates. The DAT became negative by 40 day after surgery. The patients were discharged in stable conditions after performed treatment. Since we suppose the possible development of hemolytic crisis after ABO non-identical transplantation in future, we have included the immunohematological assays such as monitoring DAT along with HLA antibody screening in post-transplant period. In our opinion, the results of DAT and the antibodies specificity in eluate should be considered when transfusion of RBC is indicated.

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Section: Discussionmentioning

confidence: 95%

“…In most cases PLS can be treated only with transfusions. (Chandra A. andet. al., 2012, Panaro F. andet al, 2004).…”

Section: Discussionmentioning

confidence: 99%

Hemolytic Crisis after AB0-Nonidentical Solid Transplantation: Case Report

Pashkova¹,

Гилевич²,

Porhanov³

2014

IMMU

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“…Corticosteroids can induce remission of antibody production, thus quelling the effect of the donor-derived cells until their natural life cycle ends. [ 9 ] TPE[ 1 ] to remove the passenger lymphocyte-derived antibodies from circulation maybe helpful in patients with severe hemolysis. [ 6 ] Rituximab, a monoclonal antibody against the protein CD20 found on the surface of B cells, destroys the passenger cells and prevents further production of antibodies.…”

Section: Discussionmentioning

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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Passenger lymphocyte syndrome exhibited in a renal transplant recipient: A case report

Cited by 2 publications

References 15 publications

Hemolytic Crisis after AB0-Nonidentical Solid Transplantation: Case Report

Hemolytic Crisis after AB0-Nonidentical Solid Transplantation: Case Report

Passenger lymphocyte syndrome in a bidirectional ABO-mismatched renal transplant

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