{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T13:06:02Z","timestamp":1785330362065,"version":"3.55.0"},"reference-count":12,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"vor","delay-in-days":209,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"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":["Case Reports in Transplantation"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Passenger lymphocyte syndrome (PLS) is a rare immune\u2010mediated haemolytic complication of solid organ transplantation caused by donor\u2010derived lymphocytes producing antibodies against recipient red blood cell (RBC) antigens. Multiple alloantibodies and concomitant autoantibody formation are uncommon, particularly in ABO\u2010identical liver transplantation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Presentation<\/jats:title>\n                    <jats:p>A 56\u2010year\u2010old male underwent ABO\u2010identical but D\u2010 and Kell\u2010non\u2010identical liver transplantation. Approximately, 3 weeks posttransplantation, haemoglobin decreased to 81\u2009g\/L, and indirect antiglobulin testing identified anti\u2010D and anti\u2010E antibodies, while direct antiglobulin testing confirmed IgG\u2010coated RBCs. Subsequently, anti\u2010K alloantibodies and transient pan\u2010reactive IgG autoantibodies were detected, resulting in positive crossmatches and complicated transfusion support. Because most transfused RBC units before antibody detection were D+, E+ and K+, anti\u2010E was interpreted as probable recipient\u2010derived transfusion\u2010associated alloimmunisation, whereas anti\u2010D and anti\u2010K were consistent with donor\u2010derived PLS. Transfusion support was subsequently restricted to D\u2212, E\u2212 and K\u2212 RBC units. The patient remained clinically stable despite haemoglobin decline with serologic evidence of immune\u2010mediated RBC sensitization consistent with PLS. During 4 years of follow\u2010up, anti\u2010D and anti\u2010K antibodies disappeared, while only weak residual anti\u2010E reactivity persisted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>The simultaneous occurrence of donor\u2010derived alloantibodies, probable recipient\u2010derived alloimmunisation and transient pan\u2010reactive autoantibodies suggests broader posttransplant humoral immune activation than typically observed in classical PLS. Although clinically significant autoimmune haemolytic anaemia did not develop, the coexistence of multiple antibody specificities substantially complicated serologic interpretation and transfusion management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case highlights complex posttransplant humoral immune dysregulation involving donor\u2010derived alloantibodies, probable recipient alloimmunisation and transient autoantibody formation after ABO\u2010identical liver transplantation. The coexistence of multiple antibodies significantly complicated serologic testing and transfusion support.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1155\/crit\/8246863","type":"journal-article","created":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T12:29:41Z","timestamp":1785328181000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Passenger Lymphocyte Syndrome With Multiple Allo\u2010 and Autoantibodies Following Liver Transplantation: A Case Report"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-9377-0211","authenticated-orcid":false,"given":"Ivica","family":"Mari\u0107","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobia","family":"Gomil\u0161ek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klara","family":"\u017deleznik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,29]]},"reference":[{"key":"e_1_2_10_1_2","doi-asserted-by":"publisher","DOI":"10.21037\/aob-21-72"},{"key":"e_1_2_10_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.transci.2026.104436"},{"key":"e_1_2_10_3_2","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2023-259259"},{"key":"e_1_2_10_4_2","doi-asserted-by":"publisher","DOI":"10.6002\/ect.2021.0328"},{"key":"e_1_2_10_5_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0129658"},{"key":"e_1_2_10_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.intimp.2020.107038"},{"key":"e_1_2_10_7_2","doi-asserted-by":"publisher","DOI":"10.1111\/vox.12253"},{"key":"e_1_2_10_8_2","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.10733"},{"key":"e_1_2_10_9_2","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2020.00946"},{"key":"e_1_2_10_10_2","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000001291"},{"key":"e_1_2_10_11_2","doi-asserted-by":"publisher","DOI":"10.1111\/petr.12391"},{"key":"e_1_2_10_12_2","doi-asserted-by":"publisher","DOI":"10.3389\/fcell.2021.706171"}],"container-title":["Case Reports in Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/crit\/8246863","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1155\/crit\/8246863","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/crit\/8246863","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T12:29:42Z","timestamp":1785328182000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1155\/crit\/8246863"}},"subtitle":[],"editor":[{"given":"Richa","family":"Sharma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":12,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1155\/crit\/8246863"],"URL":"https:\/\/doi.org\/10.1155\/crit\/8246863","archive":["Portico"],"relation":{},"ISSN":["2090-6943","2090-6951"],"issn-type":[{"value":"2090-6943","type":"print"},{"value":"2090-6951","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"assertion":[{"value":"2026-02-07","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-22","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-29","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"8246863"}}