Korean J Transplant.  2022 Nov;36(Supple 1):S49. 10.4285/ATW2022.F-1643.

Optimal blood transfusion strategy in ABO-incompatible sold organ transplantation patients: perspective of passenger lymphocyte syndrome

• Shin SW
• Lee JJ
• Ju MK

• KMID: 2535253
• DOI: http://doi.org/10.4285/ATW2022.F-1643

Abstract

There has been a lack of well-constructed practical guideline on blood component transfusion in ABO-incompatible sold organ transplantation patients. According to the survey conducted in Korea, they performed a survey by e-mailing a questionnaire to blood bank specialists at 77 major hospitals in Korea. For ABO-incompatible solid organ transplant cases, the recipients ABO group was the most common choice of ABO group for RBC transfusion (70.6%), followed by group O (29.4%). The reason for transfusion of the recipients ABO group rather than the routine use of group O is lack of blood supply as well as to prevent unnecessary infusion of anti-A or anti-B antibodies. In choosing to transfuse RBCs according to this experts opinion, passen-ger lymphocyte syndrome (PLS) should be considered. PLS is unique type of graft-versus-host disease (GVHD) caused by the transfer of B-lymphocytes present in the donor graft into the recipient circulation. This circulating graft B-lymphocytes induce antibody-induced hemolysis by producing antibodies. Therefore, the patients typically show low hemoglobin and haptoglobin level and elevated lactate dehydrogenase (LDH) and bilirubin level without evidence of bleeding and thrombocytopenia. Unlike thrombotic microangiopathy (TMA), blood smear analysis does not show schistocyte. The direct antiglobulin test (DAT) can detect donor-derived antibodies on the surface of recipient RBCs. Fortunately, in most cases of PLS, symptoms generally mild and self-limited in 4–6 weeks after transplantation. Treatment of PLS is supportive care and transfusion of O RBCs. Especially after COVID-19 pandemic, problem of lack of blood storage in blood bank is getting worse. In order to prevent wastage of the transfused blood by unnecessary hemolysis, appropriate screening protocol for PLS is important. If a decrease in hemoglobin is observed without definite bleeding within 4 weeks after transplantation, preemptive DAT should be performed to confirm PLS before transfusion.