{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T15:29:46Z","timestamp":1781191786705,"version":"3.54.1"},"reference-count":22,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2024,3,1]],"date-time":"2024-03-01T00:00:00Z","timestamp":1709251200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Transfusion"],"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>This case describes passenger lymphocyte syndrome (PLS) generating human platelet antigen 1a (HPA\u20101a) alloantibodies against the recipient's platelets after liver transplant. Given the rarity of PLS, especially in liver transplant with HPA\u20101a alloantibodies, disease course and management options are poorly described.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The patient had cirrhosis secondary to nonalcoholic steatohepatitis complicated by hepatocellular carcinoma, encephalopathy, and severe ascites. The model for end\u2010stage liver disease (MELD) score was 15 at presentation. The patient developed hepatic artery thrombosis after an orthotopic liver transplant and was relisted for transplant with a MELD score of 40. The patient received a hepatitis C virus antibody positive, hepatitis C virus nucleic amplification test positive donor liver on postoperative day (POD) 7 after first transplant. On POD 7 after the second transplant, the patient developed profound thrombocytopenia refractory to platelet infusion. They were found to have serum antibody to HPA\u20101a based upon serum platelet alloantibody testing. The donor was later found to be negative for HPA\u20101a by genetic testing. However, the patient's native platelets were HPA\u20101a positive. The patient was diagnosed with PLS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The patient's treatment course included 57\u2009units of platelets transfused, emergency splenectomy, rituximab, plasma exchange, intravenous immunoglobulin (IVIG), eltrombopag, romiplostim, and efgartigimod.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>The synergistic effect of efgartigimod with eltrombopag and romiplostim most likely resolved the patient's thrombocytopenia. This case represents a novel use of efgartigimod in the treatment of passenger lymphocyte syndrome following liver transplant.<\/jats:p><\/jats:sec>","DOI":"10.1111\/trf.17748","type":"journal-article","created":{"date-parts":[[2024,3,1]],"date-time":"2024-03-01T08:08:21Z","timestamp":1709280501000},"page":"755-760","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Successful treatment of severe passenger lymphocyte syndrome with efgartigimod synergy"],"prefix":"10.1111","volume":"64","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7505-8985","authenticated-orcid":false,"given":"R. Christopher","family":"Chase","sequence":"first","affiliation":[{"name":"Division of Internal Medicine Mayo Clinic  Jacksonville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andree H.","family":"Koop","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology Mayo Clinic  Jacksonville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marwan","family":"Shaikh","sequence":"additional","affiliation":[{"name":"Division of Hematology and Oncology Mayo Clinic  Jacksonville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robin J.","family":"Imperial","sequence":"additional","affiliation":[{"name":"Division of Hematology and Oncology Mayo Clinic  Jacksonville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denise M.","family":"Harnois","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology Mayo Clinic  Jacksonville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole M.","family":"Loo","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology Mayo Clinic  Jacksonville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer J.","family":"O'Brien","sequence":"additional","affiliation":[{"name":"Laboratory Medicine and Pathology Mayo Clinic  Jacksonville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,3]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.tmrv.2020.06.004"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v24.i13.1386"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2019001414"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.seminhematol.2013.06.008"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.14572"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.transci.2023.103711"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2019000868"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2019032227"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/0198-8859(92)90036-M"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/trf.13950"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000001669"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/lt.21539"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1177\/0961203320983450"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199911113412004"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.24944"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.2147\/DDDT.S299591"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1517\/14656566.2015.1085512"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1177\/1756286421997381"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40265-022-01678-3"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1172\/JCI97911"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.25680"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.4084\/MJHID.2023.021"}],"container-title":["Transfusion"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/trf.17748","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,4,9]],"date-time":"2024-04-09T19:00:11Z","timestamp":1712689211000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/trf.17748"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3]]},"references-count":22,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2024,4]]}},"alternative-id":["10.1111\/trf.17748"],"URL":"https:\/\/doi.org\/10.1111\/trf.17748","archive":["Portico"],"relation":{},"ISSN":["0041-1132","1537-2995"],"issn-type":[{"value":"0041-1132","type":"print"},{"value":"1537-2995","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,3]]},"assertion":[{"value":"2023-05-13","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-01-30","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-03-01","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}