title: Passenger lymphocyte syndrome in liver transplant recipients: a description of 12 cases.
abstract: BACKGROUND
  Passenger lymphocyte syndrome is an important cause of immune haemolysis after solid organ transplantation. It mainly occurs in minor ABO and Rh mismatched transplants. The haemolysis is usually mild and self-limited. We present our experience in passenger lymphocyte syndrome and liver transplantation and review the literature.
  
  
  METHODS
  We reviewed liver transplants performed in our centre from January 2002 to September 2013, searching for ABO or Rh incompatibility and serological findings of haemolysis. A direct antiglobulin test was systematically performed in each pre-transfusion assessment.
  
  
  RESULTS
  A total of 1,217 liver transplants were performed and 12 passenger lymphocyte syndromes were detected: of the 56 cases with minor ABO incompatibility, ten patients developed passenger lymphocyte syndrome (17.9%) and of 147 cases with minor Rh incompatibility, two patients developed the syndrome (1.40%). All patients with passenger lymphocyte syndrome had haemolysis, a decrease of haemoglobin (median 6.8 g/dL) and an increase of bilirubin (median 5.15 mg/dL). The treatment of passenger lymphocyte syndrome consisted of increasing the dose of corticosteroids that the patients were receiving as post-transplantation immunosuppressive therapy and, in the majority of cases, transfusion of donor compatible red blood cells.
  
  
  CONCLUSIONS
  Passenger lymphocyte syndrome in liver transplantation has significant clinical consequences. It is, therefore, important to make the diagnosis rapidly, performing pre-transfusion direct antiglobulin tests, and manage the problem correctly with donor compatible red blood cell transfusions and/or immunosuppressive treatment.
authors.affiliation: Department of Haematology and Haemotherapy, La Fe University Hospital, Valencia, Spain.
authors.forename: Samuel
authors.initials: S
authors.lastname: Romero
authors.affiliation: Department of Haematology and Haemotherapy, La Fe University Hospital, Valencia, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Solves
authors.affiliation: Department of Haematology and Haemotherapy, La Fe University Hospital, Valencia, Spain.
authors.forename: Aima
authors.initials: A
authors.lastname: Lancharro
authors.affiliation: Department of Haematology and Haemotherapy, La Fe University Hospital, Valencia, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Cano
authors.affiliation: Department of Haematology and Haemotherapy, La Fe University Hospital, Valencia, Spain.
authors.forename: Federico
authors.initials: F
authors.lastname: Moscardó
authors.affiliation: Department of Haematology and Haemotherapy, La Fe University Hospital, Valencia, Spain.
authors.forename: Nelly
authors.initials: N
authors.lastname: Carpio
authors.affiliation: Department of Haematology and Haemotherapy, La Fe University Hospital, Valencia, Spain.
authors.forename: Miguel Á
authors.initials: MÁ
authors.lastname: Sanz
mesh_terms: D000017:ABO Blood-Group System / Q000097:blood*; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000328:Adult; D001787:Blood Group Incompatibility / Q000188:drug therapy*; D005260:Female; D006461:Hemolysis; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012204:Rh-Hr Blood-Group System / Q000097:blood; D013577:Syndrome
chemical_list: D000017:ABO Blood-Group System; D000305:Adrenal Cortex Hormones; D012204:Rh-Hr Blood-Group System