Passenger Lymphocyte Syndrome After Pediatric Liver Transplantation

• Published in: Journal of pediatric gastroenterology and nutrition Vol. 69; no. 1; pp. 95 - 101
• Main Authors: Woolfson, Jessica P., Vandriel, Shannon M., Stephens, Derek, Dharmaraj, Blossom G., De Angelis, Maria, Cattral, Mark S., Ghanekar, Anand, Grant, David R., Avitzur, Yaron, Ng, Vicky L.
• Format: Journal Article
• Language: English
• Published: United States by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology 01.07.2019
• Subjects: anemia; blood transfusion; hemolysis; nonidentical compatible graft
• DOI: 10.1097/MPG.0000000000002337
• ISSN: 0277-2116

ABSTRACT Background: Passenger lymphocyte syndrome (PLS) is a less known etiology of acute onset anemia following ABO‐compatible (ABO‐c) liver transplantation (LT). Available literature on PLS after pediatric LT is limited. Therefore, we evaluated the prevalence, clinical course, and risk factors of PLS in children following ABO‐c LT. Methods: A single‐center retrospective review of all children who underwent LT between 2000 and 2017 was performed. PLS was defined as a drop‐in hemoglobin >20 g/L within 30 days of LT, with positive direct antiglobulin test and 1 laboratory test confirming hemolysis. Chi square and student t tests compared variables between subjects with and without PLS. Results: Amongst 333 pediatric LT performed, 51 children received an ABO‐c graft. PLS was diagnosed in 7 (14%) subjects at a median of 10 days after LT. There were no significant differences in patient demographics, graft type, or immunosuppression between those who did and did not develop PLS. Recipient blood group A+ receiving a donor O+ graft was a risk factor for PLS (P = 0.015). All PLS subjects recovered with blood transfusions (median 2), and no additional interventions. Three subjects initially received recipient (instead of donor) blood group red cells. Conclusions: We report a 14% prevalence of PLS following pediatric ABO‐c LT. Recipient blood group A+ receiving a donor O+ graft is a risk factor for PLS. Recognition of PLS as a cause of early acute anemia in pediatric ABO‐c LT enables timely transfusion with donor (rather than recipient) blood group red cells.