A 42-year-old male with CRE-V due to diabetic nephropathy.
He received KT from a living donor on September 10, 2012.
The donor is O+ blood group and A+ receptor.
Initial immunosuppression included tacrolimus, mycophenolate and steroids.
After the RT the evolution was very good.
At discharge she presented hemoglobin 11.4 g/dl and Crp 1.4 mg/dl.
Fourteen days later she presented with general malaise and severe hemolytic anemia was detected (hemoglobin 4.3 g/dl).
Complementary tests ruled out active bleeding.
In the blood smear no schistocytes were observed and direct Coombs test was positive with presence of anti-A antibodies.
The diagnosis was alloimmune hemolytic anemia (SPL).
The patient was treated with transfusion of 12 highdose concentrates (methylprednisolone 1 mg/kg/day) with progressive decrease.
Hematological symptoms resolved within 10 days with stable hemoglobin without requiring new transfusions.
On day 31 after transplantation, acute rejection II-B with negative donor antibodies was diagnosed, requiring treatment with thymoglobulin.
After this, renal function became stable and Crp was 3.2 mg/dl.
PLS should be suspected in sudden anemic episode in the first second week after transplantation in SOT with minor ABO incompatibility or Rh different1-5.
Its duration is limited in time (adequately 3 months)1-3.
Blood transfusion of the donor group and administration of steroids are recommended.
Rituximab and/or plasmapheresis1-5 have been used in severe cases.
Treatment with mycophenolate mofetil is recommended due to its effect on the B1.5 line.
Prevention measures such as careful graft perfusion and elimination of lymph nodes from perirenal fat are of particular importance 1,3.
In our cases, both grafts come from living donors.
It is possible that shorter cold ischemia time and faster implantation process may also have favored the development of PLS, due to the greater number and viability of donor lymphocytes.
