title: Passenger Lymphocyte Syndrome After Simultaneous Pancreas-Kidney Transplantation: A Case Report of an Unusual Cause of Alloimmune Hemolytic Anemia.
abstract: BACKGROUND
  Passenger lymphocyte syndrome (PLS) is a disease in which the donor's lymphocytes produce antibodies to the red blood cell antigens of the recipient, causing alloimmune hemolysis.
  
  
  METHODS
  We report the case of a 39-year-old woman with stage V chronic kidney disease on hemodialysis secondary to poorly controlled diabetes mellitus type 1. She received a simultaneous pancreas-kidney transplant from a cadaver donor. The donor was A- and the recipient was A+ without initial complications with normal renal and pancreatic function, and her hemoglobin (Hb) level was 10.2 g/dL at discharge. Four weeks later she was admitted with acute pyelonephritis of the renal graft, with a Hb level of 7.5 g/dL, creatinine level of 0.7 mg/dL, and glucose level of 80 mg/dL. The study of anemia showed direct polyspecific direct Coombs weakly positive (w/+), presenting 2 alloantibodies against the Rh system: anti-D, anti-E. We increased Prednisone dose to 1 mg/kg/d and then decreased it in a pattern. Eight days after discharge, without transfusion, her Hb level was 9.9 g/dL and then it normalized.
  
  
  CONCLUSIONS
  PLS is a very rare condition and should be suspected in the first few weeks after transplantation. In our case anemia was probably due to a residual population of Rh-negative donor cells in the transplanted pancreas-kidney received. It is usually a sudden onset of hemolytic anemia in patients with a solid organ transplant and different Rh or ABO lower incompatibility.
authors.affiliation: Nephrology Department, Reina Sofia Hospital, Córdoba, Spain. Electronic address: aldohurtarte12@hotmail.com.
authors.forename: A R
authors.initials: AR
authors.lastname: Hurtarte-Sandoval
authors.affiliation: Nephrology Department, Reina Sofia Hospital, Córdoba, Spain.
authors.forename: M D
authors.initials: MD
authors.lastname: Navarro-Cabello
authors.affiliation: Hematology Department, Reina Sofia Hospital, Córdoba, Spain.
authors.forename: M A
authors.initials: MA
authors.lastname: Álvarez-Rivas
authors.affiliation: Nephrology Department, Reina Sofia Hospital, Córdoba, Spain.
authors.forename: A I
authors.initials: AI
authors.lastname: Robles-López
authors.affiliation: Nephrology Department, Reina Sofia Hospital, Córdoba, Spain.
authors.forename: M D
authors.initials: MD
authors.lastname: Salmerón-Rodríguez
authors.affiliation: Nephrology Department, Reina Sofia Hospital, Córdoba, Spain.
authors.forename: M L
authors.initials: ML
authors.lastname: Agüera-Morales
authors.affiliation: Nephrology Department, Reina Sofia Hospital, Córdoba, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Rodríguez-Benot
authors.affiliation: Nephrology Department, Reina Sofia Hospital, Córdoba, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Aljama-García
mesh_terms: D000328:Adult; D000743:Anemia, Hemolytic / Q000097:blood / Q000209:etiology / Q000276:immunology*; D001327:Autoimmune Diseases / Q000097:blood / Q000209:etiology / Q000276:immunology*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000601:surgery; D005260:Female; D006801:Humans; D007518:Isoantibodies / Q000097:blood / Q000276:immunology*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000601:surgery; D016030:Kidney Transplantation / Q000009:adverse effects*; D008214:Lymphocytes / Q000276:immunology*; D016035:Pancreas Transplantation / Q000009:adverse effects*; D013577:Syndrome
chemical_list: D007518:Isoantibodies