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Passenger Lymphocyte Syndrome Following Minor ABO-incompatible Liver Transplantation: A Case Report
Styliani Tsoukala1, Georgios C Sotiropoulos2, Nicoletta Rapti1
1Department of Critical Care, Laiko General Hospital, Athens, Greece.
Transplantation Proceedings
|May 17, 2026
Summary
Passenger lymphocyte syndrome (PLS) is a rare complication after organ transplant, causing red blood cell destruction due to donor antibodies. Early diagnosis and treatment, including transfusions and immunosuppression, are key for patient recovery.
Area of Science:
- Transplantation immunology
- Hematology
- Immunology
Background:
- Passenger lymphocyte syndrome (PLS) is a post-transplant complication.
- It arises from donor B lymphocytes producing antibodies against recipient red blood cells (RBCs).
- PLS causes delayed, immune-mediated hemolysis, often linked to ABO or Rh incompatibility.
Purpose of the Study:
- To present a case of PLS following liver transplantation.
- To highlight diagnostic challenges and management strategies for PLS.
Main Methods:
- Case report of a 51-year-old liver transplant recipient (B/Rh+).
- Donor was blood group O/Rh+.
- Diagnosis confirmed by laboratory workup and liver biopsy showing T-cell rejection and hemolysis.
Main Results:
- Patient developed jaundice and anemia on postoperative day 9.
- Immune-mediated hemolysis consistent with PLS was confirmed.
- Treatment with compatible RBC transfusion, corticosteroids, intensified immunosuppression, and rituximab led to stabilization and resolution.
Conclusions:
- PLS is a rare but significant cause of early post-transplant anemia.
- Prompt recognition and tailored transfusion strategies are vital.
- Immunomodulatory therapy is crucial for managing severe PLS cases.
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