array:21 [
  "pii" => "X2013251413052658"
  "issn" => "20132514"
  "doi" => "10.3265/Nefrologia.pre2013.May.11930"
  "estado" => "S300"
  "fechaPublicacion" => "2013-07-01"
  "documento" => "article"
  "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
  "subdocumento" => "fla"
  "cita" => "Nefrologia (English Version). 2013;33:615-6"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 5078
    "formatos" => array:3 [
      "EPUB" => 327
      "HTML" => 4122
      "PDF" => 629
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:17 [
      "pii" => "X0211699513052650"
      "issn" => "02116995"
      "doi" => "10.3265/Nefrologia.pre2013.May.11930"
      "estado" => "S300"
      "fechaPublicacion" => "2013-07-01"
      "documento" => "article"
      "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
      "subdocumento" => "fla"
      "cita" => "Nefrologia. 2013;33:615-6"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 8588
        "formatos" => array:3 [
          "EPUB" => 288
          "HTML" => 7669
          "PDF" => 631
        ]
      ]
      "es" => array:9 [
        "idiomaDefecto" => true
        "titulo" => "Síndrome del linfocito pasajero: una rara forma de anemia en el trasplante renal"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "615"
            "paginaFinal" => "616"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Passenger lymphocyte syndrome: an uncommon form of anaemia in renal transplantation"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Verónica Pascual Pérez, Verónica Pascual-Pérez, Nerea Gómez Larrambe, Nerea Gómez-Larrambe, Rocío Collantes Mateos, Rocío Collantes-Mateos, Teresa Visus Fernández de Manzanos, Teresa Visus-Fernández de Manzanos, José Manuel Urbizu Gallardo, José M. Urbizu-Gallardo, Auxiliadora Mazuecos Blanca, Auxiliadora Mazuecos-Blanca"
            "autores" => array:12 [
              0 => array:2 [
                "nombre" => "Verónica"
                "apellidos" => "Pascual Pérez"
              ]
              1 => array:2 [
                "nombre" => "Verónica"
                "apellidos" => "Pascual-Pérez"
              ]
              2 => array:2 [
                "nombre" => "Nerea"
                "apellidos" => "Gómez Larrambe"
              ]
              3 => array:2 [
                "nombre" => "Nerea"
                "apellidos" => "Gómez-Larrambe"
              ]
              4 => array:2 [
                "nombre" => "Rocío"
                "apellidos" => "Collantes Mateos"
              ]
              5 => array:2 [
                "nombre" => "Rocío"
                "apellidos" => "Collantes-Mateos"
              ]
              6 => array:2 [
                "nombre" => "Teresa"
                "apellidos" => "Visus Fernández de Manzanos"
              ]
              7 => array:2 [
                "nombre" => "Teresa"
                "apellidos" => "Visus-Fernández de Manzanos"
              ]
              8 => array:2 [
                "nombre" => "José Manuel"
                "apellidos" => "Urbizu Gallardo"
              ]
              9 => array:2 [
                "nombre" => "José M."
                "apellidos" => "Urbizu-Gallardo"
              ]
              10 => array:2 [
                "nombre" => "Auxiliadora"
                "apellidos" => "Mazuecos Blanca"
              ]
              11 => array:2 [
                "nombre" => "Auxiliadora"
                "apellidos" => "Mazuecos-Blanca"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "X2013251413052658"
          "doi" => "10.3265/Nefrologia.pre2013.May.11930"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251413052658?idApp=UINPBA000064"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699513052650?idApp=UINPBA000064"
      "url" => "/02116995/0000003300000004/v0_201502091404/X0211699513052650/v0_201502091405/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:17 [
    "pii" => "X201325141305264X"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.pre2013.Apr.11931"
    "estado" => "S300"
    "fechaPublicacion" => "2013-07-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia (English Version). 2013;33:616-8"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 8796
      "formatos" => array:3 [
        "EPUB" => 313
        "HTML" => 7852
        "PDF" => 631
      ]
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "titulo" => "Bariatric surgery, a new cause of acute renal failure"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "616"
          "paginaFinal" => "618"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Cirugía bariátrica, una nueva causa de fracaso renal agudo"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig1"
          "etiqueta" => "Fig. 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "copyright" => "Elsevier España"
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "11931_16025_49179_en_f111931.jpg"
              "Alto" => 1010
              "Ancho" => 1380
              "Tamanyo" => 251615
            ]
          ]
          "descripcion" => array:1 [
            "en" => "Creatinine progression (mg/dl) after bariatric surgery"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Pilar Fraile-Gómez, Susana Domínguez-Quibén, Josepha Sebastía-Morant, Cristina Lucas-Álvarez, José M. Tabernero-Romo"
          "autores" => array:5 [
            0 => array:2 [
              "nombre" => "Pilar"
              "apellidos" => "Fraile-Gómez"
            ]
            1 => array:2 [
              "nombre" => "Susana"
              "apellidos" => "Domínguez-Quibén"
            ]
            2 => array:2 [
              "nombre" => "Josepha"
              "apellidos" => "Sebastía-Morant"
            ]
            3 => array:2 [
              "nombre" => "Cristina"
              "apellidos" => "Lucas-Álvarez"
            ]
            4 => array:2 [
              "nombre" => "José M."
              "apellidos" => "Tabernero-Romo"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X0211699513052642"
        "doi" => "10.3265/Nefrologia.pre2013.Apr.11931"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699513052642?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X201325141305264X?idApp=UINPBA000064"
    "url" => "/20132514/0000003300000004/v0_201502091629/X201325141305264X/v0_201502091630/en/main.assets"
  ]
  "itemAnterior" => array:17 [
    "pii" => "X2013251413052666"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.pre2013.Apr.11922"
    "estado" => "S300"
    "fechaPublicacion" => "2013-07-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia (English Version). 2013;33:614-5"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 4485
      "formatos" => array:3 [
        "EPUB" => 339
        "HTML" => 3437
        "PDF" => 709
      ]
    ]
    "en" => array:9 [
      "idiomaDefecto" => true
      "titulo" => "Severe hypocalcaemia post-denosumab"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "614"
          "paginaFinal" => "615"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Hipocalcemia severa posdenosumab"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Isabel M. Martín-Baez, Raquel Blanco-García, Mario Alonso-Suárez, Cynthia Cossio-Aranibar, Laura V. Beato-Coo, Francisco Fernández-Fleming"
          "autores" => array:6 [
            0 => array:2 [
              "nombre" => "Isabel M."
              "apellidos" => "Martín-Baez"
            ]
            1 => array:2 [
              "nombre" => "Raquel"
              "apellidos" => "Blanco-García"
            ]
            2 => array:2 [
              "nombre" => "Mario"
              "apellidos" => "Alonso-Suárez"
            ]
            3 => array:2 [
              "nombre" => "Cynthia"
              "apellidos" => "Cossio-Aranibar"
            ]
            4 => array:2 [
              "nombre" => "Laura V."
              "apellidos" => "Beato-Coo"
            ]
            5 => array:2 [
              "nombre" => "Francisco"
              "apellidos" => "Fernández-Fleming"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X0211699513052669"
        "doi" => "10.3265/Nefrologia.pre2013.Apr.11922"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699513052669?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251413052666?idApp=UINPBA000064"
    "url" => "/20132514/0000003300000004/v0_201502091629/X2013251413052666/v0_201502091630/en/main.assets"
  ]
  "en" => array:10 [
    "idiomaDefecto" => true
    "titulo" => "Passenger lymphocyte syndrome: an uncommon form of anaemia in renal transplantation"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "615"
        "paginaFinal" => "616"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "Verónica Pascual Pérez, Verónica Pascual-Pérez, Nerea Gómez Larrambe, Nerea Gómez-Larrambe, Rocío Collantes Mateos, Rocío Collantes-Mateos, Teresa Visus Fernández de Manzanos, Teresa Visus-Fernández de Manzanos, José Manuel Urbizu Gallardo, José M. Urbizu-Gallardo, Auxiliadora Mazuecos Blanca, Auxiliadora Mazuecos-Blanca"
        "autores" => array:12 [
          0 => array:3 [
            "nombre" => "Verónica"
            "apellidos" => "Pascual Pérez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Ver&#243;nica"
            "apellidos" => "Pascual-P&#233;rez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Nerea"
            "apellidos" => "G&#243;mez Larrambe"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "affc"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Nerea"
            "apellidos" => "G&#243;mez-Larrambe"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "affd"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "Roc&#237;o"
            "apellidos" => "Collantes Mateos"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "Roc&#237;o"
            "apellidos" => "Collantes-Mateos"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
          6 => array:3 [
            "nombre" => "Teresa"
            "apellidos" => "Visus Fern&#225;ndez de Manzanos"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "affc"
              ]
            ]
          ]
          7 => array:3 [
            "nombre" => "Teresa"
            "apellidos" => "Visus-Fern&#225;ndez de Manzanos"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "affd"
              ]
            ]
          ]
          8 => array:3 [
            "nombre" => "Jos&#233; Manuel"
            "apellidos" => "Urbizu Gallardo"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "affc"
              ]
            ]
          ]
          9 => array:3 [
            "nombre" => "Jos&#233; M&#46;"
            "apellidos" => "Urbizu-Gallardo"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "affd"
              ]
            ]
          ]
          10 => array:4 [
            "nombre" => "Auxiliadora"
            "apellidos" => "Mazuecos Blanca"
            "email" => array:1 [
              0 => "mauxiliadora&#46;mazuecos&#46;sspa&#64;juntadeandalucia&#46;es"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          11 => array:4 [
            "nombre" => "Auxiliadora"
            "apellidos" => "Mazuecos-Blanca"
            "email" => array:1 [
              0 => "mauxiliadora&#46;mazuecos&#46;sspa&#64;juntadeandalucia&#46;es"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:4 [
          0 => array:3 [
            "entidad" => "Servicio de Nefrología, Hospital Universitario Puerta del Mar, Cádiz, Cádiz, Spain, "
            "etiqueta" => "<span class="elsevierStyleSup">a</span>"
            "identificador" => "affa"
          ]
          1 => array:3 [
            "entidad" => "Servicio de Nefrología, Hospital Universitario Puerta del Mar, Cádiz,   "
            "etiqueta" => "<span class="elsevierStyleSup">b</span>"
            "identificador" => "affb"
          ]
          2 => array:3 [
            "entidad" => "Servicio de Nefrología, Hospital Universitario de Cruces, Barakaldo, Vizcaya, Spain, "
            "etiqueta" => "<span class="elsevierStyleSup">c</span>"
            "identificador" => "affc"
          ]
          3 => array:3 [
            "entidad" => "Servicio de Nefrología, Hospital Universitario de Cruces, Barakaldo, Vizcaya,  "
            "etiqueta" => "<span class="elsevierStyleSup">d</span>"
            "identificador" => "affd"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "S&#237;ndrome del linfocito pasajero&#58; una rara forma de anemia en el trasplante renal"
      ]
    ]
    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">To the Editor&#58;</span></p><p class="elsevierStylePara">Passenger lymphocyte syndrome &#40;PLS&#41; is an alloimmune haemolytic anaemia in solid organ transplantation &#40;SOT&#41; caused by alloantibodies derived from a donor B cell clone&#44; that are transferred with the graft&#44; resulting in a secondary immune response against the recipient&#39;s red blood cells in SOT with compatible but not identical blood groups&#46;<span class="elsevierStyleSup">1-5</span> It is an uncommon entity whose frequency has been related to the size &#40;in terms of lymphoid content&#41; of the transplanted organ and is much more common in heart&#47;lung &#40;70&#37;&#41; and liver &#40;29&#37;&#41; than in renal transplantation &#40;RT&#41; &#40;9&#37;&#41;&#46;<span class="elsevierStyleSup">2&#44;3</span> The antibodies are normally anti-ABO&#44; uncommonly anti-D&#44; and there are isolated cases of anti-C&#44; anti-E&#44; anti-Kell&#44; anti-Jk and anti-Fy&#46;<span class="elsevierStyleSup">3</span></p><p class="elsevierStylePara">We report two cases of live donor RT with low ABO incompatibility who developed PLS&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">CASE 1</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">A 23-year-old male with stage V chronic kidney disease &#40;CKD-V&#41; due to polycystic kidney disease&#46; He received a live donor RT on 6 June 2011&#44; with the donor being group O&#43; and the recipient being group A&#43;&#44; without initial complications and with functional graft at discharge &#40;plasma creatinine &#91;Pcr&#93; 1&#46;1mg&#47;dl&#41; and haemoglobin 10g&#47;dl&#46; Immunosuppressive therapy consisted of tacrolimus&#44; mycophenolate&#44; and steroids&#46;</p><p class="elsevierStylePara">Fourteen days after transplantation&#44; laboratory tests were performed and we observed haemoglobin of 5&#46;8 g&#47;dl with stable renal function &#40;Pcr 1&#46;2mg&#47;dl&#41; and the remaining complementary tests &#40;including CT and abdominal ultrasound&#41; were within the normal range&#46;</p><p class="elsevierStylePara">The anaemia work-up showed haemolytic anaemia &#40;low haptoglobin and high reticulocytes and direct bilirubin&#41; with positive direct Coombs test and appearance of anti-A antibodies in the patient&#39;s red blood cell preparation&#44; compatible with alloimmune haemolytic anaemia &#40;PLS&#41;&#46; The patient was treated with transfusion of 4 packed red blood cell units and methylprednisolone &#40;1mg&#47;kg&#47;day&#41; with subsequent gradually decreasing amounts&#46; Tests at discharge&#58; Pcr 0&#46;7mg&#47;dl and haemoglobin 9&#46;6g&#47;dl&#46; In the following weeks&#44; there was complete resolution and no recurrence&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">CASE 2</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">A 42-year-old male with CKD-V due to diabetic nephropathy&#46; He received a live donor RT on 10 September 2012&#46; The donor was blood group O&#43; and the recipient was A&#43;&#46; The initial immunosuppression included tacrolimus&#44; mycophenolate and steroids&#46; After the RT progression was very good&#46; At discharge he had haemoglobin of 11&#46;4g&#47;dl and Pcr of 1&#46;4mg&#47;dl&#46;</p><p class="elsevierStylePara">Fourteen days later&#44; he sought consultation due to general malaise and severe haemolytic anaemia was detected &#40;haemoglobin 4&#46;3g&#47;dl&#41;&#46; Complementary tests ruled out active bleeding&#46; The blood smear did not show schistocytes and the direct Coombs test was positive with presence of anti-A antibodies&#46; He was diagnosed with alloimmune haemolytic anaemia &#40;PLS&#41;&#46; He was treated with transfusion of 12 packed red blood cell units and high-dose steroids &#40;methylprednisolone 1mg&#47;kg&#47;day&#41; with a progressive decrease in dosage&#46; The blood abnormalities cleared within ten days and there was haemoglobin stability&#44; without further transfusions being required&#46; 31 days after transplantation&#44; he was diagnosed with II-B acute rejection with negative donor-specific antibodies&#44; and treatment with thymoglobulin was required&#46; Renal function subsequently stabilised&#44; with Pcr of 3&#46;2mg&#47;dl&#46;</p><p class="elsevierStylePara">PLS must be suspected for sudden anaemic symptoms in the first-second week after transplantation&#44; in SOT with low ABO incompatibility or different Rh&#46;<span class="elsevierStyleSup">1-5</span> Its duration is limited in time &#40;about 3 months&#41;&#46;<span class="elsevierStyleSup">1-3</span> Blood transfusion of the donor group and steroid administration are recommended&#46; In severe cases&#44; rituximab and&#47;or plasmapheresis have been used&#46;<span class="elsevierStyleSup">1-5</span> Immunosuppressive therapy with mycophenolate is recommended for its effect on B cells&#46;<span class="elsevierStyleSup">1&#44;5</span> Prevention measures&#44; such as careful graft perfusion and removal of lymph nodes from perirenal fat<span class="elsevierStyleSup">1&#44;3</span> are particularly important&#46; In our cases&#44; the two grafts came from living donors&#46; It is possible that the lower cold ischaemia time and higher speed in the implantation process also favoured the development of PLS&#44; due to the greater number and viability of the donor&#8217;s lymphocytes&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The authors declare that they have no conflicts of interest related to the contents of this article&#46;</p>"
    "pdfFichero" => "P1-E557-S4311-A11930-EN.pdf"
    "tienePdf" => true
    "bibliografia" => array:2 [
      "titulo" => "Bibliography"
      "seccion" => array:1 [
        0 => array:1 [
          "bibliografiaReferencia" => array:5 [
            0 => array:3 [
              "identificador" => "bib1"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Peces R, Díaz Corte C, Navascués RA. Hemolytic anemia caused by graft-versus-host reaction in ABO-nonidentical renal transplants from blood group O donors. Nefrologia 2001;21(4):395-401. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11816517" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib2"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Ainsworth CD, Crowther MA, Treleaven D, Evanovitch D, Webert KE, Blajchman MA. Severe hemolytic anemia post-renal transplantation produced by donor anti-D passenger lymphocytes: case report and literature review. Transfus Med Rev 2009;23(2):155-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19304116" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib3"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Yazer MH, Triulzi DJ. Immune hemolysis following ABO-mismatched stem cell or solid organ transplantation. Curr Opin Hematol 2007;14(6):664-70. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17898572" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib4"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Achkar R, Chiba AK, Zampieri-Filho JP, Pestana JO, Bordin JO. Hemolytic anemia after kidney transplantation: a prospective analysis. Transfusion 2011;51(11):2495-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21615748" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib5"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Debska-Slizie¿ A, Chamienia A, Król E, Zdrojewski Z, Pirski I, Zadrozny D, et al. Hemolytic anemia after renal transplantation: analysis of case reports. Transplant Proc 2003;35(6):2233-37."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/20132514/0000003300000004/v0_201502091629/X2013251413052658/v0_201502091630/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "35437"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Letters to the Editor - Brief Case Reports"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003300000004/v0_201502091629/X2013251413052658/v0_201502091630/en/P1-E557-S4311-A11930-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251413052658?idApp=UINPBA000064"
]
Share
Journal Information
Vol. 33. Issue. 4.July 2013
Pages 443-622
Full text access
Passenger lymphocyte syndrome: an uncommon form of anaemia in renal transplantation
Síndrome del linfocito pasajero: una rara forma de anemia en el trasplante renal
Visits
9656
Verónica Pascual Péreza, Verónica Pascual-Pérezb, Nerea Gómez Larrambec, Nerea Gómez-Larrambed, Rocío Collantes Mateosa, Rocío Collantes-Mateosb, Teresa Visus Fernández de Manzanosc, Teresa Visus-Fernández de Manzanosd, José Manuel Urbizu Gallardoc, José M. Urbizu-Gallardod, Auxiliadora Mazuecos Blancaa, Auxiliadora Mazuecos-Blancab
a Servicio de Nefrología, Hospital Universitario Puerta del Mar, Cádiz, Cádiz, Spain,
b Servicio de Nefrología, Hospital Universitario Puerta del Mar, Cádiz,
c Servicio de Nefrología, Hospital Universitario de Cruces, Barakaldo, Vizcaya, Spain,
d Servicio de Nefrología, Hospital Universitario de Cruces, Barakaldo, Vizcaya,
This item has received
Article information
Full Text
Bibliography
Download PDF
Statistics
Full Text

To the Editor:

Passenger lymphocyte syndrome (PLS) is an alloimmune haemolytic anaemia in solid organ transplantation (SOT) caused by alloantibodies derived from a donor B cell clone, that are transferred with the graft, resulting in a secondary immune response against the recipient's red blood cells in SOT with compatible but not identical blood groups.1-5 It is an uncommon entity whose frequency has been related to the size (in terms of lymphoid content) of the transplanted organ and is much more common in heart/lung (70%) and liver (29%) than in renal transplantation (RT) (9%).2,3 The antibodies are normally anti-ABO, uncommonly anti-D, and there are isolated cases of anti-C, anti-E, anti-Kell, anti-Jk and anti-Fy.3

We report two cases of live donor RT with low ABO incompatibility who developed PLS.

 

CASE 1

 

A 23-year-old male with stage V chronic kidney disease (CKD-V) due to polycystic kidney disease. He received a live donor RT on 6 June 2011, with the donor being group O+ and the recipient being group A+, without initial complications and with functional graft at discharge (plasma creatinine [Pcr] 1.1mg/dl) and haemoglobin 10g/dl. Immunosuppressive therapy consisted of tacrolimus, mycophenolate, and steroids.

Fourteen days after transplantation, laboratory tests were performed and we observed haemoglobin of 5.8 g/dl with stable renal function (Pcr 1.2mg/dl) and the remaining complementary tests (including CT and abdominal ultrasound) were within the normal range.

The anaemia work-up showed haemolytic anaemia (low haptoglobin and high reticulocytes and direct bilirubin) with positive direct Coombs test and appearance of anti-A antibodies in the patient's red blood cell preparation, compatible with alloimmune haemolytic anaemia (PLS). The patient was treated with transfusion of 4 packed red blood cell units and methylprednisolone (1mg/kg/day) with subsequent gradually decreasing amounts. Tests at discharge: Pcr 0.7mg/dl and haemoglobin 9.6g/dl. In the following weeks, there was complete resolution and no recurrence.

 

CASE 2

 

A 42-year-old male with CKD-V due to diabetic nephropathy. He received a live donor RT on 10 September 2012. The donor was blood group O+ and the recipient was A+. The initial immunosuppression included tacrolimus, mycophenolate and steroids. After the RT progression was very good. At discharge he had haemoglobin of 11.4g/dl and Pcr of 1.4mg/dl.

Fourteen days later, he sought consultation due to general malaise and severe haemolytic anaemia was detected (haemoglobin 4.3g/dl). Complementary tests ruled out active bleeding. The blood smear did not show schistocytes and the direct Coombs test was positive with presence of anti-A antibodies. He was diagnosed with alloimmune haemolytic anaemia (PLS). He was treated with transfusion of 12 packed red blood cell units and high-dose steroids (methylprednisolone 1mg/kg/day) with a progressive decrease in dosage. The blood abnormalities cleared within ten days and there was haemoglobin stability, without further transfusions being required. 31 days after transplantation, he was diagnosed with II-B acute rejection with negative donor-specific antibodies, and treatment with thymoglobulin was required. Renal function subsequently stabilised, with Pcr of 3.2mg/dl.

PLS must be suspected for sudden anaemic symptoms in the first-second week after transplantation, in SOT with low ABO incompatibility or different Rh.1-5 Its duration is limited in time (about 3 months).1-3 Blood transfusion of the donor group and steroid administration are recommended. In severe cases, rituximab and/or plasmapheresis have been used.1-5 Immunosuppressive therapy with mycophenolate is recommended for its effect on B cells.1,5 Prevention measures, such as careful graft perfusion and removal of lymph nodes from perirenal fat1,3 are particularly important. In our cases, the two grafts came from living donors. It is possible that the lower cold ischaemia time and higher speed in the implantation process also favoured the development of PLS, due to the greater number and viability of the donor’s lymphocytes.

 

Conflicts of interest

 

The authors declare that they have no conflicts of interest related to the contents of this article.

Bibliography
[1]
Peces R, Díaz Corte C, Navascués RA. Hemolytic anemia caused by graft-versus-host reaction in ABO-nonidentical renal transplants from blood group O donors. Nefrologia 2001;21(4):395-401. [Pubmed]
[2]
Ainsworth CD, Crowther MA, Treleaven D, Evanovitch D, Webert KE, Blajchman MA. Severe hemolytic anemia post-renal transplantation produced by donor anti-D passenger lymphocytes: case report and literature review. Transfus Med Rev 2009;23(2):155-9. [Pubmed]
[3]
Yazer MH, Triulzi DJ. Immune hemolysis following ABO-mismatched stem cell or solid organ transplantation. Curr Opin Hematol 2007;14(6):664-70. [Pubmed]
[4]
Achkar R, Chiba AK, Zampieri-Filho JP, Pestana JO, Bordin JO. Hemolytic anemia after kidney transplantation: a prospective analysis. Transfusion 2011;51(11):2495-9. [Pubmed]
[5]
Debska-Slizie¿ A, Chamienia A, Król E, Zdrojewski Z, Pirski I, Zadrozny D, et al. Hemolytic anemia after renal transplantation: analysis of case reports. Transplant Proc 2003;35(6):2233-37.
Download PDF
Idiomas
Nefrología (English Edition)
Article options
Tools
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?