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Severe passenger lymphocyte syndrome associated to Rh antibodies after donor living renal transplantation

Passenger B lymphocyte syndrome (PBLS) has been described after hematopoietic progenitors and solid organ transplantation1,2 and may occur when there is a minor erythrocyte antigen mismatch between donor and recipient. It is mediated by graft B lymphocytes that recognize erythrocyte antigens as non-self with subsequent alloimmune response causing hemolytic anemia, through the production of antibodies against recipient red cell antigens. PBLS incidence in kidney transplantation (KT) varies between 9 and 20% according to publications1-3. It is predominantly mediated by ABO isoagglutinins and rarely by Rh antibodies. A Coombs positive anemia 7-14 days after a transplant with minor blood antigens incompatibility should raise diagnostic suspicion for this entity2. A correct and prompt management is essential to ensure a good outcome.