21 May 2009
Ann Transplant 2009; 14(1): 53-53 :: ID: 880392
Background: Encapsulating peritoneal sclerosis (EPS) is rare but serious
complication in patients on peritoneal dialysis (PD). It is defined as intermittent or recurrent intestinal obstruction with or without signs of inï¬‚ammation and the existence of peritoneal thickening, sclerosis, calcifications and encapsulation. Aim: We describe 4 post-transplant EPS cases occurring in our centre.
Material/Methods: From December 1994 to December 2008, some 69 PD patients received kidney transplantation (KT) and 4 of them (3 m, 1 f) developed EPS. Mean age of all PD patients was 39.9±12.4 and those with EPS 48.3 (range 42-59) years. RRT duration time of all PD patients was 19.7 (range 1-93) months, while patients with EPS 103.8 (range 56-192) months. EPS patients were maintained on PD for 71.3 (range 56-89) months. All required high volume dialysis to achieve its adequacy (APD), two received icodextrin, all but one were high transporters, one had returning intrperitoneal bleeding, all received beta-blockers, all had peritonitis incidents (1-2).
Results: Described patients developed severe symptoms of intestinal obstruction, and required surgical intervention within 1-3 months after KT. Diagnosis was based on: clinical symptoms, macroscopic inspection, radiological and histopathological findings. Treatment consisted of: adhesiolysis, parenteral nutrition (PN) (2/4) and tamoxifen. 49 months since EPS diagnosis and after 27 months of PN one patient died. The other live with well functioning grafts (19, 20 and 23 months after KT); one is still on PN, all receive tamoxifen, steroids, tacrolimus and mycophenolate mofetil. Conclusions: EPS should be considered when bowel obstructive symptoms appear in a long term PD patients undergoing KT. These patients may take advantage from such therapeutic measures as adhesiolysis, chronic PN and tamoxifen. Early enrolment to transplantation waiting list should be considered in all suitable PD patients.
Keywords: Kidney Transplantation
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