title: Passenger lymphocyte syndrome in ABO and Rhesus D minor mismatched liver and kidney transplantation: A prospective analysis.
abstract: The increasing demand for solid organs has necessitated the use of ABO and Rhesus (Rh) D minor mismatched transplants. The passenger lymphocyte syndrome (PLS) occurs when donor lymphocytes produce antibodies that react with host red blood cell (RBC) antigens and result in hemolysis. Our aim was to evaluate prospectively the role of PLS in post transplant anemia and hemolysis in ABO and RhD minor mismatched recipients of liver and kidney grafts and to study the association of PLS with donor lymphocyte microchimerism. We examined 11 liver and 10 kidney recipients at Day +15 for anemia, markers of hemolysis, direct antiglobulin test and eluates, and serum RBC antibodies. Microchimerism was determined in peripheral blood lymphocytes by genotyping of simple sequence length polymorphisms encoding short tandem repeats. Immune hemolytic anemia and anti-recipient RBC antibodies were observed in 2 out of 11 liver (18.2%) and 2 out of 10 kidney (20%) transplants. RBC antibody specificity reflected the donor to recipient transplant, with anti-blood group B antibodies identified in 2 cases of O to B and 1 case of A to AB transplants while anti-D antibodies were detected in 1 case of RhD-negative to RhD-positive transplant. Donor microchimerism was found in only 1 patient. In conclusion, passenger lymphocyte mediated hemolysis is frequent in minor mismatched liver and kidney transplantation. Recognizing PLS as a potential cause of post transplant anemia may allow for early diagnosis and management to decrease the morbidity and mortality in some patients.
authors.affiliation: Department of Clinical Pathology, Cairo University, Cairo, Egypt.
authors.forename: Mervat
authors.initials: M
authors.lastname: ElAnsary
authors.affiliation: Department of Clinical Pathology, Cairo University, Cairo, Egypt. Electronic address: mariamhanna@hotmail.com.
authors.forename: Mariam Onsy F
authors.initials: MO
authors.lastname: Hanna
authors.affiliation: Department of Internal Medicine and Nephrology, Cairo University, Cairo, Egypt.
authors.forename: Gamal
authors.initials: G
authors.lastname: Saadi
authors.affiliation: Department of General Surgery, Cairo University, Cairo, Egypt.
authors.forename: Mostafa
authors.initials: M
authors.lastname: ElShazly
authors.affiliation: Department of Pediatric Nephrology, Cairo University, Cairo, Egypt.
authors.forename: Fatina I
authors.initials: FI
authors.lastname: Fadel
authors.affiliation: Department of Pediatric Nephrology, Cairo University, Cairo, Egypt.
authors.forename: Hanan AbdElAziz
authors.initials: HA
authors.lastname: Ahmed
authors.affiliation: National Liver Institute, Shebeen El-Kom, Menufia, Egypt.
authors.forename: Amr Mostafa
authors.initials: AM
authors.lastname: Aziz
authors.affiliation: National Liver Institute, Shebeen El-Kom, Menufia, Egypt.
authors.forename: Amal
authors.initials: A
authors.lastname: ElSharnouby
authors.affiliation: Blood Transfusion Center, Cairo University, Cairo, Egypt.
authors.forename: Mona MohiElDin T
authors.initials: MM
authors.lastname: Kandeel
mesh_terms: D000017:ABO Blood-Group System / Q000235:genetics / Q000276:immunology*; D000328:Adult; D000743:Anemia, Hemolytic / Q000209:etiology / Q000235:genetics / Q000276:immunology* / Q000473:pathology; D001787:Blood Group Incompatibility / Q000209:etiology / Q000235:genetics / Q000276:immunology* / Q000473:pathology; D046528:Chimerism; D005260:Female; D015870:Gene Expression; D005838:Genotype; D006461:Hemolysis / Q000276:immunology; D006650:Histocompatibility Testing; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D016031:Liver Transplantation / Q000009:adverse effects*; D008214:Lymphocytes / Q000276:immunology / Q000473:pathology; D008297:Male; D018895:Microsatellite Repeats; D011446:Prospective Studies; D012204:Rh-Hr Blood-Group System / Q000235:genetics / Q000276:immunology*; D018029:Rho(D) Immune Globulin / Q000096:biosynthesis; D013577:Syndrome; D014019:Tissue Donors
chemical_list: D000017:ABO Blood-Group System; C061961:RHO(D) antibody; D012204:Rh-Hr Blood-Group System; D018029:Rho(D) Immune Globulin
keywords: Blood group; Hemolytic anemia; Microchimerism; Passenger lymphocyte syndrome; Transplantation