Severe hemolytic anemia due to passenger lymphocytes after living-related bowel transplant.
BACKGROUND
Hemolytic anemia following solid organ transplant may be caused by 'passenger' lymphocytes producing antibodies against erythrocytes. This phenomenon has never been described after intestinal transplant.


METHODS
We report a case of severe, immune-mediated hemolysis due to symptomatic passenger lymphocyte syndrome (PLS) in a 4-yr-old recipient of living donor small bowel transplant. The Coombs'-positive hemolysis was caused by anti-A,B antibodies derived from donor lymphocytes in an ABO-compatible donor-recipient pair (O into A).


RESULTS
This complication was successfully and efficiently treated by the novel combined use of group O RBC transfusion, plasmapheresis and rituximab (anti-CD20).


CONCLUSIONS
A severe hemolytic anemia due to PLS can occur in bowel transplantation. This complication should be considered when performing ABO-incompatible bowel transplant with a blood group O donor and an A or B recipient. Treatment with plasmapheresis, blood group O transfusion and rituximab has proved successful in our case.
Panaro
F
F
Department of Surgery, Transplant Division, University of Illinois at Chicago, Chicago, IL, USA.
DeChristopher
P J
PJ
Rondelli
D
D
Testa
G
G
Sankary
H
H
Popescu
M
M
Benedetti
E
E
D000017:ABO Blood-Group System / Q000276:immunology; D000743:Anemia, Hemolytic / Q000209:etiology / Q000276:immunology* / Q000628:therapy; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D058846:Antibodies, Monoclonal, Murine-Derived; D002675:Child, Preschool; D017707:Erythrocyte Transfusion; D004912:Erythrocytes / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007422:Intestines / Q000637:transplantation*; D019520:Living Donors; D008214:Lymphocytes / Q000276:immunology*; D008297:Male; D016377:Organ Transplantation / Q000009:adverse effects* / Q000379:methods; D010956:Plasmapheresis / Q000379:methods; D000069283:Rituximab; D016896:Treatment Outcome
D000017:ABO Blood-Group System; D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D007166:Immunosuppressive Agents; D000069283:Rituximab