High Rate of Passenger Lymphocyte Syndrome after ABO Minor Incompatible Lung Transplantation

Area of Science:

• Transplantation Immunology
• Hematology
• Pulmonary Medicine

Background:

• Passenger lymphocyte syndrome (PLS) can occur after lung transplantation (LuTX), particularly with minor ABO incompatibility.
• Donor-derived red cell antibodies can induce hemolysis in recipients, leading to PLS.
• Understanding the incidence and clinical impact of PLS is vital for patient management.

Purpose of the Study:

• To determine the incidence and specificity of PLS-associated antibodies in lung transplant recipients.
• To analyze the dynamics of hemolysis and transfusion needs in patients with and without PLS.
• To compare outcomes between recipients with and without PLS following ABO-incompatible LuTX.

Main Methods:

• Retrospective cohort study of 1,011 LuTX patients (2010-2019) and prospective analysis of 87 LuTX patients (2019-2021).
• Postoperative assessment of ABO antibodies, hemolytic markers, transfusion requirements, and hospital stay.
• Comparison of blood group A recipients of O grafts with and without PLS.

Main Results:

• PLS incidence was 18.18% (retrospective) and 30.77% (prospective) in A recipients of O grafts.
• Anti-A and anti-A1 were the primary PLS-inducing antibodies; PLS patients had lower hemoglobin and higher transfusion rates.
• No significant differences were observed in other laboratory markers, hospital stay duration, or other complications.

Conclusions:

• Minor ABO incompatible LuTX recipients face a substantial risk of clinically significant PLS.
• Post-transplant monitoring combining red cell serology and hemolysis markers is recommended.
• Early detection of hemolytic episodes is essential for initiating appropriate antigen-negative transfusion therapy.