Transplantation proceedings · 2026
Passenger Lymphocyte Syndrome Following Minor ABO-incompatible Liver Transplantation: A Case Report.
СтатьяКлинический случайНазвание и аннотация: Перевод в очереди
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Tsoukala Styliani, Sotiropoulos Georgios C, Rapti Nicoletta, Ampelioti Sevasti, Sarantos Konstantinos, Stergiou Ioanna, Xanthis Dimitrios, Vernikos Pavlos, Paramythiotou Elisabeth
Аннотация
BACKGROUND: Passenger lymphocyte syndrome (PLS) is a graft-versus-host immune complication after solid organ or hematopoietic stem cell transplantation, typically arising from minor ABO or Rh incompatibility. It is caused by the transfer of viable donor B lymphocytes that produce alloantibodies against recipient red blood cell (RBC) antigens. The syndrome presents as delayed, immune-mediated hemolysis and can be clinically significant.
CASE PRESENTATION: We report a 51-year-old woman (blood group B/Rh-positive) who underwent liver transplantation from a blood group O/Rh-positive donor. On postoperative day 9, she developed jaundice and a significant drop in hemoglobin, with no overt clinical signs of hemorrhage. Liver biopsy revealed moderate T-cell mediated rejection and laboratory workup confirmed immune-mediated hemolysis, consistent with PLS. Management included donor compatible red blood cell transfusion, corticosteroids, intensified immunosuppression, and monoclonal antibodies (rituximab), which resulted in stabilization and subsequent resolution of hemolysis.
CONCLUSIONS: Although rare, PLS should be considered in the differential diagnosis of early post-transplant anemia. Prompt recognition and appropriate transfusion strategy, with immunomodulatory therapy in severe cases, are crucial for favorable outcomes.
CASE PRESENTATION: We report a 51-year-old woman (blood group B/Rh-positive) who underwent liver transplantation from a blood group O/Rh-positive donor. On postoperative day 9, she developed jaundice and a significant drop in hemoglobin, with no overt clinical signs of hemorrhage. Liver biopsy revealed moderate T-cell mediated rejection and laboratory workup confirmed immune-mediated hemolysis, consistent with PLS. Management included donor compatible red blood cell transfusion, corticosteroids, intensified immunosuppression, and monoclonal antibodies (rituximab), which resulted in stabilization and subsequent resolution of hemolysis.
CONCLUSIONS: Although rare, PLS should be considered in the differential diagnosis of early post-transplant anemia. Prompt recognition and appropriate transfusion strategy, with immunomodulatory therapy in severe cases, are crucial for favorable outcomes.