03703nas a2200445   4500008004100000020001400041024001700055245019500072210006900267260015500336300001300491490000700504520204600511653004902557653003902606653004902645653001902694653004202713653001002755653005102765653001102816653003002827653001102857653004602868653003202914653000902946653001602955653001302971653001802984100003503002700002303037700002203060700002203082700002603104700001803130700002303148700002103171700002003192856004503212       2009                        eng d  a1532-9496  abe5, 870902700aPassenger lymphocyte syndrome with or without immune hemolytic anemia in all Rh-positive recipients of lungs from rhesus alloimmunized donors: three new cases and a review of the literature.0 aPassenger lymphocyte syndrome with or without immune hemolytic a  aUnited StatesbCserti-Gazdewich,Christine M. University Health Network/Toronto General Hospital, Toronto, ON, Canada. christine.cserti@uhn.on.cac2009  a134 - 450 v233 aThe passenger lymphocyte syndrome (PLS) is an unusual complication of solid organ transplantation, in which donor lymphocytes produce antibodies reactive with host red blood cell (RBC) antigens. Risks for PLS include highly lymphoid grafts, past sensitization of the donor against relevant RBC antigens, and donor lymphocyte escape of host immune clearance. For a 1-year period at our center, we observed an uncommonly high frequency of post-lung transplant Rhesus PLS, occurring once in every 31 cases. Passenger lymphocyte syndrome resulted from 2 alloimmunized cadaveric donors, in 3 of 3 D+, ABO-identical but HLA-unmatched recipients who initially had nonreactive RBC antibody screens. In case 1, the right lung of a group A, D-negative donor, with antibodies against D, C, and E antigens, was transplanted into a group A, R1R1 recipient. The recipient developed severe hemolytic anemia, direct antiglobulin test (DAT)-positive, on postoperative day (POD) 17. Anti-D and anti-C were identified on both the indirect antiglobulin test (IAT) and the RBC eluate. She required 10 U of RBCs in 40 days as well as plasmapheresis (POD 36-40). When transfusion dependence ceased, anti-D +/- C remained detectable on DAT and IAT for another 6.5 months. In case 2, the group A, R1r recipient of the same donor's left lung exhibited anti-D for the first time at posttransplant month 4 on both IAT and DAT. This activity persisted until a rejection episode 5 months later, without ever causing any evidence of hemolysis. In case 3, the group O, R1R1 recipient of both lungs of a group O, D-negative donor, with antibodies against D, C, and V antigens, developed a nonhemolytic DAT and IAT with anti-D +/- C at postoperative month 2, which remained positive at last follow-up (6 months posttransplant). In conclusion, this report suggests a high incidence of Rhesus antibody PLS after lung transplantation, with wide variations in the timing of antibody onset, persistence, and severity. A review of the phenomenon and its implications are discussed.10a*Anemia, Hemolytic, Autoimmune/et [Etiology]10a*Autoimmune Diseases/et [Etiology]10a*Blood Group Incompatibility/im [Immunology]10a*Isoantibodies10a*Lung Transplantation/im [Immunology]10aAdult10aBlood Group Incompatibility/co [Complications]10aFemale10aHemolysis/im [Immunology]10aHumans10aLung Transplantation/ae [Adverse Effects]10aLymphocytes/im [Immunology]10aMale10aMiddle Aged10aSyndrome10aTissue Donors1 aCserti-Gazdewich, Christine, M1 aWaddell, Thomas, K1 aSinger, Lianne, G1 aChaparro, Cecilia1 aPendergrast, Jacob, M1 aHawes, Janice1 adenHollander, Neal1 aTinckam, Kathryn1 aKeshavjee, Shaf  uhttps://notifylibrary.org/reference/4114