Passenger Lymphocyte Syndrome: A Rare Case of Anemia After Liver Transplant.

Passenger lymphocyte syndrome is a rare presentation of posttransplant anemia caused by donor antibodies that target recipient red blood cells. We present a classic case of passenger lymphocyte syndrome in a liver transplant recipient who developed anemia due to immune-mediated hemolysis. He presented 3 weeks posttransplant with shortness of breath and fatigue and was found to have severe anemia with a significant reduction in hemoglobin levels. Evaluation revealed antibody-mediated hemolysis consistent with the diagnosis of passenger lymphocyte syndrome. For these patients, treatment is mainly supportive; however, steroid treatment can be considered. Although rare, passenger lymphocyte syndrome should be part of the differential diagnosis when evaluating posttransplant anemia.

Primary sclerosing cholangitis and pancreatic cancer: A retrospective cohort study of United States veterans.

Primary sclerosing cholangitis (PSC) is associated with hepatobiliary and colorectal cancers, but it remains uncertain if PSC increases the risk for pancreatic cancer. While some European studies have suggested an increased risk of pancreatic cancer in PSC patients, other studies have not. And these studies did not well account for presence or absence of concomitant inflammatory bowel disease (IBD). The purpose of this study is to investigate the prevalence of pancreatic cancer in United States veterans with PSC both with and without IBD. Methods: This retrospective study used International Classification of Diseases, Tenth Revision (ICD-10) codes to identify patients with PSC, IBD, and pancreatic cancer from the Veterans Affairs (VA) Corporate Data Warehouse. The prevalence of pancreatic cancer in patients with PSC only, IBD only, PSC with IBD, and neither PSC nor IBD were compared. Logistic regression was used to control for age, gender, chronic pancreatitis, diabetes mellitus, and tobacco and alcohol use. Results: A total of 946 patients with PSC were identified from a population of over 9 million veterans. 486 (51.4%) of these had concurrent IBD. Additionally 112,653 patients with IBD without PSC were identified. When adjusted for confounding factors, patients with PSC had a significantly higher prevalence of pancreatic cancer compared to the general population and those with IBD without PSC (2.4% vs. 0.2% and 0.5%, respectively). Conclusions: Veterans with PSC, particularly those without concomitant IBD, have a high prevalence of pancreatic cancer compared to the general veteran population. Our findings support the need for multicenter prospective studies investigating the benefits of screening for pancreatic cancer in patients with PSC.