Passenger Lymphocytic Syndrome following orthoptic diseased donor liver transplantation

Chamali Mahindika Aluwihare,Gita Jeganathan,Anuja Abayadeera

doi:10.4038/slja.v26i2.8318

Abstract

Passenger lymphocytic syndrome (PLS) is a complication of solid organ and stem cell transplant where minor ABO incompatibility between the donor and the recipient (most commonly A recipient, O donor) causes a compliment mediated haemolysis of the recipient’s red blood cells (RBC). Immunocompetent donor B lymphocytes are transferred passively with the graft and generate antibodies that will bind to recipient’s RBCs causing haemolysis. We report a case of a 58-year-old gentleman who underwent an orthoptic diseased donor liver transplantation with a minor ABO incompatibility (donor O positive, recipient A positive) who subsequently went into PLS following an A positive blood transfusion intra operatively and in the immediate post-operative period. He developed features of acute haemolysis attributable to PLS. He made a good recovery with supportive measures and subsequent O positive blood transfusion. PLS should be suspected in a patient with a minor ABO incompatibility with drop in Haemoglobin (Hb) without evidence of active bleeding. The direct agglutination test (DAT) may not be always positive. High degree of suspicion and supportive measures can make a complete recovery in this group of patients.

Highlights

IntroductionPassenger lymphocytic syndrome (PLS) is a complication of solid organ and stem cell transplant where minor ABO incompatibility between the donor and the recipient (most commonly A recipient, O donor) causes a complement mediated haemolysis of the recipient’s red blood cells (RBC)
Passenger lymphocytic syndrome (PLS) is a complication of solid organ and stem cell transplant where minor ABO incompatibility between the donor and the recipient causes a complement mediated haemolysis of the recipient’s red blood cells (RBC)
Immunocompetent lymphocytes, present within the graft or ‘passenger lymphocytes’ are passively transferred to the recipient in the donor organ forming antibodies resulting in complement mediated RBC destruction in the recipient causing haemolysis.[2]

Summary

Introduction

Passenger lymphocytic syndrome (PLS) is a complication of solid organ and stem cell transplant where minor ABO incompatibility between the donor and the recipient (most commonly A recipient, O donor) causes a complement mediated haemolysis of the recipient’s red blood cells (RBC). We report a case of a 58-year-old gentleman who underwent an orthoptic diseased donor liver transplantation with a minor ABO incompatibility (donor O positive, recipient A positive) who subsequently developed PLS following A positive blood transfusions intra operatively and in the immediate post-operative period. He developed features of acute haemolysis attributable to PLS. He underwent an orthoptic deceased donor liver transplantation under general anaesthesia He had a 5.3 litre blood loss in theatre and received 10 units of A positive blood (3000ml), 9 packs of A positive platelets, 50 units of cryoprecipitate and 2000mls of fresh frozen plasma (FFP) and was started on i.v. piperacillin tazobactam and teicoplanin intra-operatively. The patient was closely monitored for features of haemolytic anaemia in the postoperative period

Discussion

Conclusion