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Abstract: SA-PO851

Passenger Lymphocyte Syndrome in Post-Transplant Patients

Session Information

Category: Transplantation

  • 2002 Transplantation: Clinical

Authors

  • Memon, Aliza Anwar, Saint Louis University, Saint Louis, Missouri, United States
  • Fleetwood, Vidya, Saint Louis University, Saint Louis, Missouri, United States
  • Hermelin, Daniela, Saint Louis University, Saint Louis, Missouri, United States
  • Malvik, Natalie, Saint Louis University, Saint Louis, Missouri, United States
  • Caliskan, Yasar, Saint Louis University, Saint Louis, Missouri, United States
  • Bastani, Bahar, Saint Louis University, Saint Louis, Missouri, United States
  • Abu Al Rub, Fadee, Saint Louis University, Saint Louis, Missouri, United States
  • Vo, Thanh-Mai Nguyen, Saint Louis University, Saint Louis, Missouri, United States
  • Edwards, John C., Saint Louis University, Saint Louis, Missouri, United States
  • Lentine, Krista L., Saint Louis University, Saint Louis, Missouri, United States
Introduction

Passenger Lymphocyte Syndrome (PLS) is an immune mediated hemolysis directed against recipient red blood cells as the result of the concurrent transplantation of allograft derived "passenger" lymphocytes. It is an uncommon phenomenon that occurs in the setting of minor ABO mismatched solid organ transplant. We present a unique case of PLS due to Rh-incompatibility.

Case Description

A Rh positive 61-year-old man with end stage kidney disease underwent a deceased donor kidney transplant from a Rh-negative donor. Allograft started to function and patient was discharged at postop day 7. He was re admitted after two weeks with a low hemoglobin level. Work up for anemia was significant for elevated lactate dehydrogenase, unconjugated bilirubin, undetectable haptoglobin, and schistocytes on the peripheral smear. Flow cytometry for paroxysmal nocturnal hemoglobinuria and G6PD level were within normal limits. The antibody screen and direct antiglobulin test (DAT) became positive which were previously negative. The DAT showed strong reactivity with the anti-IgG reagent which was associated with anti-D antibodies in patient’s plasma. Results of RHD genotyping testing showed no associated variants in this patient. However, a premortem donor blood specimen was recovered, which revealed the presence of anti-D and anti-C antibodies in the donor’s plasma. The diagnosis of PLS due to anti-D antibody was made. Patient received supportive treatment with Rh D and C antigen negative blood, steroids and rituximab infusions. Three months from transplant, the patient is stable with a down trending anti-D titer.

Discussion

PLS should be suspected in cases of sudden anemia following solid organ transplant. The timing of this occurrence is consistent with an anamnestic immune response. Having an awareness of this potential phenomenon can aid in prompt diagnosis and treatment which can range from transfusion support to immunosuppressive therapy.

Hemoglobin trend in Passenger Lymphocyte Syndrome