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Haematology
Passenger lymphocyte syndrome following minor ABO-mismatched liver transplantation
  1. Akash Mathavan1,
  2. Urszula Krekora2,
  3. Andrew Chase Kleehammer1 and
  4. Akshay Mathavan1
  1. 1Internal Medicine, University of Florida, Gainesville, Florida, USA
  2. 2College of Medicine, University of Central Florida, Orlando, Florida, USA
  1. Correspondence to Dr Akshay Mathavan; amathavan1996{at}ufl.edu

Abstract

Passenger lymphocyte syndrome is an immunologic disorder observed in solid organ and haematopoietic stem cell transplantation in which B lymphocytes within a donor graft are transferred to the recipient and subsequently produce circulating antibodies against host red blood cell antigens. The syndrome is most likely to occur in minor ABO blood group mismatched or Rh incompatible transplantation. Although generally mild and self-limited, the resulting haemolytic burden has the potential to increase the risk of infection, graft failure and death. The phenomenon is observed in the transplantation of any solid organ with lymphoid tissue, including the liver. We present a structured case report of passenger lymphocyte syndrome following minor ABO-mismatched liver transplantation, which was initially complicated by blood loss anaemia early in the postoperative period. By reviewing the limited literature of this disorder following liver transplantation, we emphasise common clinical findings and treatment strategies as well as introduce chimerism analysis to confirm resolution.

  • Haematology (incl blood transfusion)
  • Immunology
  • Cirrhosis
  • Alcoholic liver disease
  • Malignant and Benign haematology

https://doi.org/10.1136/bcr-2023-259259

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    Footnotes

    • Contributors Akash M conceived of the idea for the case report and was primarily responsible for writing the manuscript. UK contributed to background research and manuscript drafting. ACK helped with background research and manuscript drafting. Akshay M assisted with writing the manuscript, provided subject matter expertise and is responsible for its final content. The following authors were responsible for drafting the text, sourcing and editing of clinical images, investigating results, drawing original diagrams and algorithms, and critical revision for important intellectual content: Akash M, UK, ACK and Akshay M. The following authors gave final approval of the manuscript: Akash M, UK, ACK and Akshay M.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.