Successful Treatment of Life-Threatening Small Bowel Bleeding With Thalidomide After Living Donor Kidney Transplantation: A Case Report

• DOI: 10.1016/j.transproceed.2019.07.009
• Publication Date: 2019-10-14T21:08:21Z
• Authors: Yoonjung Heo; Hyung Sub Park; Chang Sik Shin; Kwon Cheol Yoo; Daehwan Kim; Taeseung Lee
• Keywords: Male; 0301 basic medicine; Angiogenesis Inhibitors; Middle Aged; Kidney Transplantation; Tacrolimus; Thalidomide; 3. Good health; 03 medical and health sciences; Postoperative Complications; Melena; Living Donors; Humans; Gastrointestinal Hemorrhage; Immunosuppressive Agents; Aged

Gastrointestinal bleeding after kidney transplantation is a complication that can occur from immunosuppressant use. We present a case of refractory small bowel bleeding treated successfully with thalidomide after multiple failed attempts of conventional treatment. A 65-year-old male patient with diabetic nephropathy underwent living donor kidney transplantation. The surgery was uneventful, however, he developed immunosuppressant-induced melena with unstable vital signs 11 days later. There were a total of 4 bleeding episodes until the 90th postoperative day, and he received a total of 290 units of red blood cell transfusion during this period. Endoscopic clipping, transarterial embolization, and 2 surgical interventions failed to stop the bleeding. A trial of thalidomide 100 mg per day finally stopped the bleeding and the patient was discharged on the 110th postoperative day with a functioning renal graft. This case shows that thalidomide can be a safe option to treat immunosuppressant-induced refractory gastrointestinal bleeding in the setting of kidney transplantation. Additionally, this is the first case that reports the survival of a renal graft after more than 3000 mL of transfusion.