Donor anti-Jk(a) causing hemolysis in a liver transplant recipient.
BACKGROUND
Hemolytic transfusion reactions have been observed in recipients of ABO- and/or D-mismatched marrow, peripheral blood, and solid organs. Passenger lymphocyte syndrome occurs when immunocompetent donor lymphocytes transferred during transplantation produce alloantibodies against host antigens.


METHODS
The first case of a delayed, anti-Jk(a)-mediated hemolytic reaction in a liver transplant recipient, caused by passenger donor lymphocytes, is reported here. A 43-year-old man underwent liver transplantation. Six weeks later, the patient underwent a second liver transplant. On Day 10 of the second transplant, clinical hemolysis ensued; anti-Jk(a) was detected. The patient's DAT became positive, and anti-Jk(a) was eluted from his RBCs. On Day 35 of the patient's second transplant, 3 weeks after the last blood transfusion, the patients' DAT was still weakly positive with anti-Jk(a) in the eluate. Six months later, serum antibody screening was negative, but the DAT was still weakly positive. The patient's RBCs tested Jk(a+), whereas the second donor's RBCs were Jk(a-).


CONCLUSIONS
This is the first documentation of clinically significant hemolysis caused by anti-Jk(a), produced by passenger lymphocytes transferred from the donor's liver to the transplant recipient.
Hareuveni
Mara
M
Sourasky Medical Center, Tel Aviv, Israel.
Merchav
Hadar
H
Austerlitz
Neomi
N
Rahimi-Levene
Naomi
N
Ben-Tal
Ofira
O
Rahimi-Leveen
Neomi
N
D000017:ABO Blood-Group System / Q000276:immunology; D000328:Adult; D000743:Anemia, Hemolytic / Q000276:immunology; D001787:Blood Group Incompatibility / Q000276:immunology; D001788:Blood Grouping and Crossmatching; D001803:Blood Transfusion; D004912:Erythrocytes / Q000276:immunology; D006461:Hemolysis / Q000276:immunology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007518:Isoantibodies / Q000097:blood; D007667:Kidd Blood-Group System / Q000276:immunology*; D016031:Liver Transplantation; D008214:Lymphocytes / Q000276:immunology*; D008297:Male; D014019:Tissue Donors
D000017:ABO Blood-Group System; D007166:Immunosuppressive Agents; D007518:Isoantibodies; D007667:Kidd Blood-Group System