Passenger lymphocyte syndrome in ABO and Rhesus D minor mismatched liver and kidney transplantation: A prospective analysis

El-Ansary, Mervat; Hanna, Mark P.; Saadi, Gamal; El-Shazly, Mostafa; Fadel, Fatina; Ahmed, Hanan AbdelAziz; Aziz, Amr Mostafa; ElSharnouby, Amal; Kandeel, Mona MohiElDin T.

doi:10.1016/j.humimm.2015.03.006

Cited by 22 publications

(33 citation statements)

References 34 publications

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“…It is hypothesized that immunosuppressive agents that cause deep recipient T-lymphocyte suppression, such as basiliximab and calcineurin inhibitors, relatively spare humoral immunity. This could lead to donor B cell activation and thus enhancement of antibody production 19. Only two of our patients received basiliximab and both developed PLS.…”

Section: Discussionmentioning

confidence: 90%

“…Only two of our patients received basiliximab and both developed PLS. Agents noted to reduce B cell antibody production, such as azathioprine and mycophenolate mofetil, may be more beneficial 12,18,19…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, knowledge of PLS and its risk factors is extremely important for transplant physicians. Unfortunately, it is not possible to predict which recipients of minor ABO-incompatible transplantations will develop PLS 17,19. Cserti-Gazdewich et al 20.…”

Section: Discussionmentioning

confidence: 99%

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Passenger Lymphocyte Syndrome (PLS): A Single-center Retrospective Analysis of Minor ABO-incompatible Liver Transplants

Bruijn

Philipse

Couttenye

et al. 2017

Journal of Clinical and Translational Hepatology

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Background and Aims: Due to the shortage of donor livers, minor ABO-incompatible liver transplantations are commonly performed. Together with the allograft, immunocompetent B-lymphocytes, called passenger lymphocytes, are transplanted. In case of minor ABO-incompatibility, these passenger lymphocytes produce antibodies directed towards the recipients red blood cells, which causes immune-mediated hemolysis, also known as the passenger lymphocyte syndrome (PLS). Although this is a self-limiting disorder, serious complications can occur, including graft failure. Retrospectively, we evaluated the role of PLS in minor ABO-incompatible liver transplantations performed at our center. Methods: A retrospective analysis was conducted for all minor ABO-incompatible liver transplantations performed at the Antwerp University Hospital between 2003 and 2015. All patient files were inspected for clinical and laboratory findings. In cases of PLS diagnosis, the applied treatment was also studied. Results: In total, 10 patients underwent a minor ABOincompatible liver transplantation and 4 showed signs of PLS. All 4 PLS patients were treated with different therapeutic strategy, corresponding to the severity of hemolysis. In all 4 cases, PLS resolved following treatment. Conclusion: When performing minor ABO-incompatible liver transplantations, knowledge of PLS is elemental. Next to a high index of clinical suspicion, we suggest routine screening for markers of hemolysis, with emphasis on haptoglobin level and direct antiglobulin test, weekly in the first 4 weeks post-transplantation

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

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Passenger Lymphocyte Syndrome (PLS): A Single-center Retrospective Analysis of Minor ABO-incompatible Liver Transplants

Bruijn

Philipse

Couttenye

et al. 2017

Journal of Clinical and Translational Hepatology

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“…Antibodies against minor blood group antigens like Rhesus and Lewis antigens can also cause hemolysis . Clinically significant hemolysis requiring blood transfusions has been reported to occur in about 70%, 40% and 17% in ABO NCI heart‐lung, liver and kidney transplants respectively . The hemolysis is usually transient, occurring within the first 3 months after transplant, and can be treated with monitoring and transfusion of donor blood type specific PRBCs.…”

Section: Discussionmentioning

confidence: 99%

“…21 Antibodies against minor blood group antigens like Rhesus and Lewis antigens can also cause hemolysis. [23][24][25] Clinically significant hemolysis requiring blood transfusions has been reported to occur in about 70%, 40% and 17% in ABO NCI heart-lung, liver and kidney transplants respectively. 21,23 The hemolysis is usually transient,…”

Section: Discussionmentioning

confidence: 99%