{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T04:01:36Z","timestamp":1780113696424,"version":"3.54.0"},"reference-count":25,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T00:00:00Z","timestamp":1780012800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T00:00:00Z","timestamp":1780012800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Transfusion Medicine"],"abstract":"Abstract<\/jats:title>\n \n Objective<\/jats:title>\n To investigate the incidence and risk factors of Passenger Lymphocyte Syndrome (PLS) following ABO minor\u2010incompatible lung transplantation.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A retrospective analysis was performed on 211 lung transplantations conducted between January 2022 and July 2025, including 58 cases involving ABO minor\u2010incompatibility. The diagnosis of PLS was established based on evidence of haemolysis, a positive direct antiglobulin test (DAT), and confirmation of donor\u2010derived antibodies. Clinical characteristics and outcomes were compared between the PLS and non\u2010PLS groups using statistical analyses.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The overall incidence of PLS was 3.32% (7\/211), with a markedly higher rate of 12.07% (7\/58) observed among ABO minor\u2010incompatible transplants. Of the seven PLS cases, six occurred in O\u2010to\u2010non\u2010O donor\u2013recipient pairs. Risk factor analysis revealed that female sex (\n p<\/jats:italic>\n \u2009<\u20090.001), bilateral lung transplantation (\n p<\/jats:italic>\n \u2009=\u20090.027), and preoperative anaemia (\n p<\/jats:italic>\n \u2009<\u20090.001) were significantly associated with the development of PLS. Furthermore, patients with PLS experienced several adverse postoperative outcomes, including lower nadir haemoglobin levels (43.50\u2009g\/L vs. 77.00\u2009g\/L in controls,\n p<\/jats:italic>\n \u2009=\u20090.001) and platelet counts (29.00\u2009\u00d7\u200910\n 9<\/jats:sup>\n \/L vs. 101.00\u2009\u00d7\u200910\n 9<\/jats:sup>\n \/L,\n p<\/jats:italic>\n \u2009=\u20090.001), substantially higher median red blood cell transfusion requirements (23.25\u2009units vs. 0.00\u2009units in controls,\n p<\/jats:italic>\n \u2009<\u20090.001), and prolonged median hospital stays (75.50\u2009days vs. 32.00\u2009days,\n p<\/jats:italic>\n \u2009=\u20090.002).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n PLS occurs at a relatively high frequency following ABO minor\u2010incompatible lung transplantation. It is associated with risk factors such as female sex, bilateral lung transplantation, and preoperative anaemia, and contributes to more pronounced postoperative declines in haemoglobin and platelet levels, increased transfusion requirements, and extended hospitalisation.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/tme.70087","type":"journal-article","created":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T03:03:45Z","timestamp":1780110225000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Incidence and risk factors of passenger lymphocyte syndrome after\n ABO<\/scp>\n minor\u2010incompatible lung transplantation"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-8850-0111","authenticated-orcid":false,"given":"Ci","family":"Xuan","sequence":"first","affiliation":[{"name":"Department of Blood Transfusion First Affiliated Hospital of Guangzhou Medical University Guangzhou Guangdong China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhu","family":"Boping","sequence":"additional","affiliation":[{"name":"Department of Blood Transfusion First Affiliated Hospital of Guangzhou Medical University Guangzhou Guangdong China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2582-2687","authenticated-orcid":false,"given":"Huang","family":"Junting","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine First Affiliated Hospital of Guangzhou Medical University Guangzhou Guangdong China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Su","family":"Xiaoqian","sequence":"additional","affiliation":[{"name":"Department of Blood Transfusion First Affiliated Hospital of Guangzhou Medical University Guangzhou Guangdong China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hu","family":"Caiting","sequence":"additional","affiliation":[{"name":"Department of Blood Transfusion First Affiliated Hospital of Guangzhou Medical University Guangzhou Guangdong China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Qiuhua","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine First Affiliated Hospital of Guangzhou Medical University Guangzhou Guangdong China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mo","family":"Xuyou","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine First Affiliated Hospital of Guangzhou Medical University Guangzhou Guangdong China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-6463-511X","authenticated-orcid":false,"given":"Li","family":"Yiquan","sequence":"additional","affiliation":[{"name":"Department of Blood Transfusion First Affiliated Hospital of Guangzhou Medical University Guangzhou Guangdong China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,29]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.trim.2022.101605","article-title":"Passenger lymphocyte syndrome in renal transplantation: a systematic review of published case reports","volume":"73","author":"Zhao H","year":"2022","journal-title":"Transpl Immunol"},{"issue":"1","key":"e_1_2_11_3_1","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1186\/s13019-019-0846-6","article-title":"ABO\u2010identical matching has no superiority in long\u2010term survival in comparison to ABO\u2010compatible matching in lung transplantation","volume":"14","author":"Fakhro M","year":"2019","journal-title":"J Cardiothorac Surg"},{"issue":"4","key":"e_1_2_11_4_1","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1111\/j.1744-313X.2012.01101.x","article-title":"ABO\u2010incompatible organ transplantation","volume":"39","author":"Subramanian V","year":"2012","journal-title":"Int J Immunogenet"},{"key":"e_1_2_11_5_1","doi-asserted-by":"crossref","DOI":"10.3389\/fped.2023.1092412","article-title":"Outcomes after ABO incompatible pediatric liver transplantation are comparable to ABO identical\/compatible transplant","volume":"11","author":"Lemoine CP","year":"2023","journal-title":"Front Pediatr"},{"issue":"6","key":"e_1_2_11_6_1","doi-asserted-by":"crossref","first-page":"664","DOI":"10.1097\/MOH.0b013e3282e9a576","article-title":"Immune hemolysis following ABO\u2010mismatched stem cell or solid organ transplantation","volume":"14","author":"Yazer MH","year":"2007","journal-title":"Curr Opin Hematol"},{"issue":"8","key":"e_1_2_11_7_1","doi-asserted-by":"crossref","first-page":"995","DOI":"10.1164\/rccm.202306-1107OC","article-title":"High rate of passenger lymphocyte syndrome after ABO minor incompatible lung transplantation","volume":"209","author":"Kohl MM","year":"2024","journal-title":"Am J Respir Crit Care Med"},{"issue":"2","key":"e_1_2_11_8_1","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1016\/j.healun.2012.11.020","article-title":"Passenger lymphocyte syndrome mimicking hemolytic uremic syndrome after lung transplantation","volume":"32","author":"Horlait G","year":"2013","journal-title":"J Heart Lung Transplant"},{"issue":"8","key":"e_1_2_11_9_1","doi-asserted-by":"crossref","DOI":"10.3390\/ijms25084296","article-title":"Autoimmune hemolytic anemias: classifications, pathophysiology, diagnoses and management","volume":"25","author":"Loriamini M","year":"2024","journal-title":"Int J Mol Sci"},{"key":"e_1_2_11_10_1","doi-asserted-by":"crossref","DOI":"10.1155\/2008\/715769","article-title":"Passenger lymphocyte syndrome and liver transplantation","volume":"2008","author":"Audet M","year":"2008","journal-title":"Clin Dev 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