de Bruijn Sévérine, Philipse Ester, Couttenye Marie Madeleine, Bracke Bart, Ysebaert Dirk, Michielsen Peter, Francque Sven, Vanwolleghem Thomas, Verlinden Anke
Departments of Hematology, Antwerp University Hospital, Edegem, Belgium.
Departments of Nephrology, Antwerp University Hospital, Edegem, Belgium.
J Clin Transl Hepatol. 2017 Mar 28;5(1):9-15. doi: 10.14218/JCTH.2016.00072. Epub 2017 Mar 20.
Due to the shortage of donor livers, minor ABO-incompatible liver transplantations are commonly performed. Together with the allograft, immunocompetent B-lymphocytes, called passenger lymphocytes, are transplanted. In case of minor ABO-incompatibility, these passenger lymphocytes produce antibodies directed towards the recipient's red blood cells, which causes immune-mediated hemolysis, also known as the passenger lymphocyte syndrome (PLS). Although this is a self-limiting disorder, serious complications can occur, including graft failure. Retrospectively, we evaluated the role of PLS in minor ABO-incompatible liver transplantations performed at our center. A retrospective analysis was conducted for all minor ABO-incompatible liver transplantations performed at the Antwerp University Hospital between 2003 and 2015. All patient files were inspected for clinical and laboratory findings. In cases of PLS diagnosis, the applied treatment was also studied. In total, 10 patients underwent a minor ABO-incompatible liver transplantation and 4 showed signs of PLS. All 4 PLS patients were treated with different therapeutic strategy, corresponding to the severity of hemolysis. In all 4 cases, PLS resolved following treatment. When performing minor ABO-incompatible liver transplantations, knowledge of PLS is elemental. Next to a high index of clinical suspicion, we suggest routine screening for markers of hemolysis, with emphasis on haptoglobin level and direct antiglobulin test, weekly in the first 4 weeks post-transplantation as well as in case of a sudden hemoglobin drop within the first 3 months after transplantation. Peri- and postoperative transfusion support using donor-compatible blood has been suggested to prevent the occurrence or limit the extent of hemolysis.
由于供体肝脏短缺，临床上常进行次要不相容ABO血型的肝移植手术。移植的同时，具有免疫活性的B淋巴细胞（即过客淋巴细胞）也会随之移植。在次要不相容ABO血型的情况下，这些过客淋巴细胞会产生针对受者红细胞的抗体，从而引发免疫介导的溶血，即所谓的过客淋巴细胞综合征（PLS）。尽管这是一种自限性疾病，但仍可能出现严重并发症，包括移植失败。我们通过回顾性研究评估了PLS在本中心进行的次要不相容ABO血型肝移植中的作用。对2003年至2015年间在安特卫普大学医院进行的所有次要不相容ABO血型肝移植手术进行了回顾性分析。检查了所有患者的临床和实验室检查结果，并对诊断为PLS的病例所采用的治疗方法进行了研究。共有10例患者接受了次要不相容ABO血型肝移植，其中4例出现了PLS的症状。所有4例PLS患者均根据溶血的严重程度采用了不同的治疗策略。经治疗后，所有4例患者的PLS均得到缓解。在进行次要不相容ABO血型肝移植时，了解PLS至关重要。除了要保持高度的临床怀疑外，我们建议常规筛查溶血标志物，重点关注触珠蛋白水平和直接抗球蛋白试验，在移植后的前4周每周进行一次，以及在移植后前3个月内血红蛋白突然下降的情况下进行检查。建议采用供体相容血型的血液进行围手术期输血支持，以预防溶血的发生或限制溶血的程度。
