PASSENGER LYMPHOCYTE SYNDROME IN LIVING DONOR KIDNEY TRANSPLANTATION AFTER RITUXIMAB TREATMENT

Abstract

Passenger lymphocyte syndrome (PLS) is an alloimmune hemolytic anemia occurring in patients undergoing hematopoietic stem cell or solid organ transplantation. The etiology of PLS is thought to involve passive transfer of donor-derived antibody-producing cells. Here, we report a case of PLS which developed following kidney transplantation from an ABO-incompatible living donor despite pretreatment of the recipient with rituximab for desensitization.

The recipient was a female in her 60's whose blood group was A and RhD positive. The donor was her husband, also in his 60's. As his blood group was B and RhD positive, she was treated with desensitization therapy using rituximab and other immunosuppressants before transplantation. She developed hemolytic anemia on post-operative day (POD) 4 and received red blood cell transfusion. However, the effect of transfusion was transient and the anemia gradually progressed. Crossmatch testing performed on POD 16 was incompatible and donor-derived anti-A antibody was detected. She was therefore transfused with group O-washed red cells (WRC). Although WRC transfusion was initially effective, her hemoglobin level continued to gradually decrease and she required repeated transfusion of WRC.

PLS should be considered as a cause of hemolytic anemia after transplantation. Detection of donor-derived alloantibodies by the direct antiglobulin test, antibody elution test, and ABO reverse typing at the indirect antiglobulin test is important.