Successful Treatment of Gastrointestinal Bleeding With Recombinant Factor VIIa After Kidney Transplantation in Patients With Pancytopenia A. Malato, A.I. Lo Monte, R. Anastasio, L. Lo Coco, I. Abbene, C. Maione, M.C. Gioviale, and S. Siragusa ABSTRACT Hemostatic disorders can often complicate transplantation procedures. Moreover, anti- hemmorhagic drugs may not efficiently control bleeding that occurs in such cases. We report on a patient who underwent kidney transplantation complicated by bone marrow aplasia and gastric bleeding who was succesfully treated with recombinant activated FVII (Novoseven). In May 2005, a 53-year-old man affected by chronic renal insufficiency underwent kidney transplantation. At the beginning of June, laboratory tests showed progressive reduction in the blood cell count with anemia, granulocytopenia, and thrombocytopenia related to the development of marrow insufficiency. We commenced transfusion therapy and administered hematologic growth factors. On June 3, 2005, the patient underwent surgical procedure to repair the abdominal wall. Two days thereafter, the postsurgical period was complicated by an episode of melena. The patient received additional treatment with packed red cells, platelets, and fresh-frozen plasma. The gastrointestinal bleeding continued until June 9, 2005, when therapy with recombinant activated FVII (Novoseven) was commenced at an initial dose of 90 gr/kg. The first bolus did not significantly reduce the blood loss; it was therefore administered as a successive bolus at the same dosage that was able to stop bleeding. Endoscopic examination performed the day after showed the absence of the hemorrhagic lesion in the gastric mucosa. In the subsequent days, the need for transfusion was dramatically reduced with no episode of bleeding. At the same time, the laboratory and clinical findings of marrow insufficiency disappeared. Our case report showed that the use of a global antihemorrhagic factor, such as Novoseven, can successfully control gastrointestinal bleeding even in complicated patients despite failure of traditional antihemostatic therapy. H EMOSTATIC DISORDERS are common among pa- tients undergoing kidney transplantation. When they occur, the management of posttransplant bleeding can be difficult. Traditional hemostatic measures based on antifi- brinolytic or transfusion therapy may not always be succes- ful. In this situation, a new antihemorrhagic recombinant activated drugs may be more appropriate since high hemo- static activity is achieved with a small volume of drug. 1 Little evidence supports the use of activated FVII (Novos- eve) in patients who underwent kidney transplantation. 2,3 Herein we have reported a patient who developed massive gastric hemorrhage after kidney transplantation with mar- row insufficiency due to immunosuppressive therapy. The hemorrhage was succesfully treated with recombinant acti- vated FVII after the inability of transfusion therapy to control the bleeding. CASE REPORT In May 2005, a 53-year-old man underwent kidney transplanta- tion because of chronic renal insufficiency. The patient was From the Haematology and Bone Marrow Unit, Department of Oncology (A.M., R.A., L.L.C., I.A., S.S.) and Department of General Surgery and Organ Transplantation (A.I.L.M., C.M., M.C.G.), University Hospital of Palermo, Palermo, Italy. Address reprint requests to Sergio Siragusa, Associate Pro- fessor of Haematology, Haematology and Bone Marrow Unit, University of Palermo, Via del Vespro 127, 90127 Palermo, Italy. E-mail: sergio.siragusa@unipa.it © 2006 by Elsevier Inc. All rights reserved. 0041-1345/06/$–see front matter 360 Park Avenue South, New York, NY 10010-1710 doi:10.1016/j.transproceed.2006.03.043 Transplantation Proceedings, 38, 1031–1033 (2006) 1031