Am J Respir Crit Care Med. 2023 Dec 11. doi: 10.1164/rccm.202306-1107OC. Online ahead of print.
ABSTRACT
RATIONALE: Passenger lymphocyte syndrome (PLS) may complicate minor ABO mismatched lung transplantation (LuTX) via donor-derived red cell antibody-induced hemolysis.
OBJECTIVES: To ascertain the incidence and specificity of PLS-relevant antibodies amongst the study population as well as the dynamics of hemolysis parameters and the transfusion requirement of patients with or without PLS were the main objectives of this study.
METHODS: In this cohort study, 1011 patients who received LuTX between January 2010 and June 2019 were studied retrospectively. Prospectively, 87 LuTX (July 2019 to June 2021) were analyzed. Post-operative ABO antibody and hemolytic marker determinations, transfusion requirement, and duration of post-operative hospital care were analyzed. Retrospectively, blood group A recipients of O grafts with PLS were compared to those without.
MEASUREMENTS AND MAIN RESULTS: PLS affected 18.18% (retrospective) and 30.77% (prospective) of A recipients receiving O grafts, 5.13% of B recipients of O grafts, and 20% of AB patients receiving O transplants. Anti-A and anti-A1 were the predominant PLS-inducing antibodies, followed by anti-B and anti-A,B. Significantly lower hemoglobin values (median 7.4 versus 8.3 g/dL; p=0.0063) and an approximately twice as high percentage of patients requiring blood transfusions were seen in PLS. No significant differences in other laboratory markers, duration of hospital stay or other complications after LuTX were registered.
CONCLUSIONS: Minor ABO incompatible LuTX recipients are at considerable risk of developing clinically significant PLS. Post-transplant monitoring combining red cell serology and hemolysis marker determination appears advisable not to overlook hemolytic episodes which necessitate antigen-negative transfusion therapy.
PMID:38078854 | DOI:10.1164/rccm.202306-1107OC
