Passenger lymphocyte syndrome after ABO-mismatched kidney transplantation: A case report and literature review

• Published in: Transplant immunology 2023-02, Vol.76, p.101725-101725, Article 101725
• Main Authors: Zhou, Dawei, Leung, Junto, Hu, Zhengbin, Ye, Shaojun, Ye, Qifa
• Format: Article
• Language: English
• Subjects: ABO Blood-Group System; Blood Group Incompatibility; Humans; Kidney Transplantation; Lymphocytes; Passenger lymphocyte syndrome; Syndrome; Transfusion; Transplantation, Homologous
• ISSN: 0966-3274; 1878-5492
• DOI: 10.1016/j.trim.2022.101725

Passenger lymphocyte syndrome (PLS) is a rare post solid organ transplantation complication, usually occurring after ABO- or Rh-mismatched transplantation. In general, PLS can lead to severe hemolytic anemia, but it is usually a self-limited disease. Most PLS cases start with a decreased hemoglobin (Hb) level and require donor type RBC transfusion as the only treatment. In our case, the allograft was given by an O-type Rh-D(+) donor and received by an A-type Rh-D(+) recipient. The PLS was developed on the post-operative day (POD) 10 with an increased indirect bilirubin (IDBIL) level as the first clinical symptom, while the Hb level did not significantly decrease. The PLS was diagnosed on POD 17 by a direct antiglobulin test (DAT) and a blood group test. The patient quickly became stable on POD 18 after a total of eight units of O-type RBC transfusion. Kidney function was uneventful in the entire PLS period. In ABO-mismatched kidney transplantation, an increased level of IDBIL should be considered as the first symptom of PLS even without an Hb decrease. The kidney function may be not affected by the PLS symptoms. •The present manuscript has reported an ABO-mismatched kidney transplant recipient who had developed passenger lymphocyte syndrome (PLS), the first symptom was an increase in IDBIL instead of anemia.•The present manuscript has reviewed literatures, summarized the diagnosis and the treatments of PLS.