Lab Med Online.  2022 Oct;12(4):310-314. 10.47429/lmo.2022.12.4.310.

A Case Report of Passenger Lymphocyte Syndrome Following Bidirectional ABO-mismatched Kidney Transplantation

• Kim J
• Song J
• Kwon SS
• Kim S
• Huh KH
• Kim HO

• KMID: 2538620
• DOI: http://doi.org/10.47429/lmo.2022.12.4.310

Abstract

Passenger lymphocyte syndrome (PLS) is a subtype of graft-versus-host disease caused by the production of antibodies by transferred donor B-lymphocytes against red blood cells (RBCs) of the recipient. A 64-year-old male diagnosed with stage five chronic kidney disease underwent bidirectional ABO-mismatched kidney transplantation. The blood groups of the recipient and the donor were A+ and B+, respectively. After transplantation, hemoglobin (Hb) levels were eventually reduced to 6.3 g/dL on postoperative day (POD) 25. Elevated lactate dehydrogenase levels and positive direct antiglobulin test results indicated immune-mediated hemolysis as a possible cause of anemia. After switching RBC transfusion from type-A to type-O and conducting plasma exchange four times, on POD 35, Hb levels of the patient recovered up to 9.1 g/dL, and the patient was discharged from the hospital without complications. To the best of our knowledge, PLS in a bidirectional ABO-mismatched solid organ transplantation has been reported once in India, and this is the first case to be reported in Korea.

Keyword

ABO antibodies; Bidirectional ABO mismatch; Passenger lymphocyte syndrome; Kidney transplantation

Figure

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  Fig. 1 Hb and LDH levels of the patient after renal transplantation. The light blue line indicates postoperative Hb level observed over time, and the orange vertical bars indicate LDH levels (LDH reference range: 119–247 IU/L). Yellow, red, and green arrows indicate transfusion of type-A RBCs, transfusion of type-O RBCs, and therapeutic plasma exchange, respectively. Abbreviations: Hb, hemoglobin; LDH, lactate dehydrogenase; RBC, red blood cell.

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  Fig. 2 ABO typing of the patient after renal transplantation. The tests were conducted, and the results were observed using an automated column agglutination technique by VISION Max (Ortho Clinical Diagnostics, Männedorf, Switzerland).

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