학술논문
High Rate of Passenger Lymphocyte Syndrome after ABO Minor Incompatible Lung Transplantation.
Document Type
Academic Journal
Author
Kohl MM; Department of Transfusion Medicine and Cell Therapy.; Schwarz S; Department of Thoracic Surgery, and.; Jaksch P; Department of Thoracic Surgery, and.; Muraközy G; Department of Thoracic Surgery, and.; Kurz M; Department of Transfusion Medicine and Cell Therapy.; Schönbacher M; Department of Transfusion Medicine and Cell Therapy.; Tolios A; Department of Transfusion Medicine and Cell Therapy.; Frommlet F; Center for Medical Statistics, Informatics, and Intelligent Systems (Institute of Medical Statistics), Medical University of Vienna, Vienna, Austria.; Hoetzenecker K; Department of Thoracic Surgery, and.; Körmöczi GF; Department of Transfusion Medicine and Cell Therapy.
Source
Publisher: American Thoracic Society Country of Publication: United States NLM ID: 9421642 Publication Model: Print Cited Medium: Internet ISSN: 1535-4970 (Electronic) Linking ISSN: 1073449X NLM ISO Abbreviation: Am J Respir Crit Care Med Subsets: MEDLINE
Subject
Language
English
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 among the study population as well as the dynamics of hemolysis parameters and the transfusion requirement of patients with or without PLS. Methods: In this cohort study, 1,011 patients who received LuTX between January 2010 and June 2019 were studied retrospectively. Prospectively, 87 LuTX (July 2019 to June 2021) were analyzed. Postoperative ABO antibody and hemolytic marker determinations, transfusion requirement, and duration of postoperative hospital care were analyzed. Retrospectively, blood group A recipients of O grafts with PLS were compared with 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-A 1 were the predominant PLS-inducing antibodies, followed by anti-B and anti-A,B. Significantly lower hemoglobin values (median, 7.4 vs. 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 so as not to overlook hemolytic episodes that necessitate antigen-negative transfusion therapy.