Diagnostics And Clinical Outcome Of A Passenger Lymphocyte Syndrome In A Female Patient After Ab0 Identical Lung Transplantation

A 60-year-old female showed platelet depletion, intermittent fever of unclear origin, diarrhea, and worsening of the general condition after initially good organ function two weeks after lung transplantation. The laboratory chemical, microbiological and imaging diagnostics did not explain the symptoms. The differential diagnosis of rejection revealed no cellular rejection from lung biopsy. In contrast to the serum test before transplantation, HLA antibodies with high signal strengths could be detected in the serum 3 weeks after transplantation, but not against the lung donor as expected but against the lung recipient. In parallel chimeric diagnosis from peripheral blood showed a donor proportion of 0.6%. The review of the lung donor anamnesis (liver transplantation 4 days before organ donation, transfusions and pregnancies) confirmed the suspicion of a "Passenger Lymphocyte Syndrome"(PLS) with the clinical symptoms of graft versus host disease (GvHD). In the subsequent weeks after transplantation, the signal strengths of the recipient-specific HLA antibodies declined and at no time donor-specific HLA antibodies could be detected. The proportion of donor in the peripheral blood also decreased during follow-up. Twelve weeks after transplantation, the patient could be discharged for rehabilitation. On basis of this case report, it should be pointed out that immunocompetent donor derived lymphocytes transferred with the transplanted organ can cause a sometimes complicated PLS with the clinical signs of GvHD.