PASSENGER LYMPHOCYTE SYNDROME IN LIVING DONOR KIDNEY TRANSPLANTATION AFTER RITUXIMAB TREATMENT

DOI Web Site 11 References
  • Sobue Koki
    Division of Blood Transfusion, Toho University Omori Medical Center
  • Okuda Makoto
    Division of Blood Transfusion, Toho University Omori Medical Center
  • Kuribayashi Tomoko
    Division of Blood Transfusion, Toho University Omori Medical Center
  • Hidaka Yoko
    Division of Blood Transfusion, Toho University Omori Medical Center
  • Yusa Takashi
    Division of Blood Transfusion, Toho University Omori Medical Center
  • Fujiwara Yuri
    Division of Blood Transfusion, Toho University Omori Medical Center
  • Ishibashi Mizuki
    Division of Blood Transfusion, Toho University Omori Medical Center
  • Saito Kohei
    Division of Blood Transfusion, Toho University Omori Medical Center
  • Suzuki Hiromu
    Division of Blood Transfusion, Toho University Omori Medical Center
  • Kishi Maiko
    Division of Blood Transfusion, Toho University Omori Medical Center
  • Saze Chika
    Division of Blood Transfusion, Toho University Omori Medical Center
  • Ono Mayuko
    Division of Blood Transfusion, Toho University Omori Medical Center
  • Higuchi Erika
    Division of Blood Transfusion, Toho University Omori Medical Center
  • Muramatsu Masaki
    Department of Nephrology, Faculty of Medicine, Toho University
  • Takahashi Hiroyuki
    Division of Blood Transfusion, Toho University Omori Medical Center
  • Sakai Ken
    Department of Nephrology, Faculty of Medicine, Toho University
  • Shiono Noritsugu
    Division of Blood Transfusion, Toho University Omori Medical Center

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  • リツキシマブ投与下の生体腎移植後にPassenger Lymphocyte Syndromeを発症した1例

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Abstract

<p>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.</p><p>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.</p><p>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.</p>

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