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Passenger Lymphocyte Syndrome after Pediatric Liver Transplantation

Woolfson, Jessica P.* , †; Vandriel, Shannon M.* , †; Stephens, Derek† , ‡; Dharmaraj, Blossom G.* , †; De Angelis, Maria† , §; Cattral, Mark S.† , § , || , ¶; Ghanekar, Anand† , § , || , ¶; Grant, David R.† , § , || , ¶; Avitzur, Yaron* , † , §; Ng, Vicky L.* , † , §

Journal of Pediatric Gastroenterology and Nutrition: March 15, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/MPG.0000000000002337
Original Article: Hepatology: PDF Only
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Background: Passenger lymphocyte syndrome (PLS) is a less known etiology of acute onset anemia following ABO-compatible (ABO-c) liver transplantation (LT). Available literature on PLS following pediatric LT is limited. Therefore, we evaluated the prevalence, clinical course and risk factors of PLS in children following ABO-c LT.

Methods: A single center retrospective review of all children who underwent LT between 2000-2017 was performed. PLS was defined as a drop-in hemoglobin >20 g/L within 30 days of LT, with positive direct antiglobulin test and one lab test confirming hemolysis. Chi square and student t-tests compared variables between subjects with and without PLS.

Results: Amongst 333 pediatric LT performed, 51 children received an ABO-c graft. PLS was diagnosed in 7 (14%) subjects at a median of 10 days after LT. There were no significant differences in patient demographics, graft type or immunosuppression between those who did and did not develop PLS. Recipient blood group A + receiving a donor O+ graft was a risk factor for PLS (p=0.015). All PLS subjects recovered with blood transfusions (median 2), and no additional interventions. Three subjects initially received recipient (instead of donor) blood group red cells.

Conclusion: We report a 14% prevalence of PLS following pediatric ABO-c LT. Recipient blood group A+ receiving a donor O+ graft is a risk factor for PLS. Recognition of PLS as a cause of early acute anemia in pediatric ABO-c LT enables timely transfusion with donor (rather than recipient) blood group red cells.

*The Hospital for Sick Children, Division of Gastroenterology, Hepatology and Nutrition, Toronto, Ontario

The University of Toronto, Toronto, Ontario

The Hospital for Sick Children, Biostatistics, Design and Analysis, Toronto, Ontario

§The Hospital for Sick Children, Division of Transplant and Regenerative Medicine, Toronto, Ontario

||Division of General Surgery, The Hospital for Sick Children, Toronto, Ontario

Division of General Surgery, University Health Network, Toronto, Ontario.

Address correspondence and reprint requests to Vicky L. Ng, The Hospital for Sick Children, Division of Pediatric Gastroenterology, Hepatology and Nutrition, 555 University Ave, Black Wing, Room 8262, Toronto, Ontario, Canada, M5G 1X8 (e-mail: vicky.ng@sickkids.ca)

Received 26 November, 2018

Accepted 22 February, 2019

Conflicts of Interest and Source of Funding:

There are no conflicts of interest to declare.

Clinical Hepatology Fellowship awarded to JP Woolfson from The Canadian Liver Foundation and the Canadian Association for the Study of Liver (CASL).

This work was presented in part as an Oral E-Poster at the 2017 European Society of Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) meeting in Geneva, Switzerland.

Authorship Statement

JP Woolfson: Participated in research design, data acquisition, analysis and interpretation, writing, drafting and revising the work for important intellectual content, final approval of the version to be published, agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

SM Vandriel: Participated in research design, drafting and revising the work for important intellectual content, final approval of the version to be published, agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

D Stephens: Participated in statistical design, data analysis and interpretation, drafting and revising the work for important intellectual content, final approval of the version to be published, agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

BG Dharmaraj: Participated in research design, drafting and revising the work for important intellectual content, final approval of the version to be published, agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

M De Angelis: Participated in research design, drafting and revising the work for important intellectual content, final approval of the version to be published, agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

MS Cattral: Participated in research design, drafting and revising the work for important intellectual content, final approval of the version to be published, agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

A Ghanekar: Participated in research design, drafting and revising the work for important intellectual content, final approval of the version to be published, agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

DR Grant: Participated in research design, drafting and revising the work for important intellectual content, final approval of the version to be published, agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Y Avitzur: Participated in research design, drafting and revising the work for important intellectual content, final approval of the version to be published, agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

VL Ng: Participated in research design, data analysis and interpretation, drafting and revising the work for important intellectual content, final approval of the version to be published, agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

© 2019 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,