mTOR inhibitors for medical treatment of post-transplantation encapsulating peritoneal sclerosis: a favourable single center experience

Messina, M; Ariaudo, Claudia; Mella, Alberto; Cantaluppi, Vincenzo; Segoloni, Giuseppe; Biancone, Luigi

doi:10.1007/s40620-014-0168-7

Cited by 12 publications

(8 citation statements)

References 37 publications

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“…This study proposed mTOR inhibitors as an effective option for EPS treatment. 26 Although the more use of tamoxifen in mTOR inhibitors arm can disturb such deduction.…”

Section: Resultsmentioning

confidence: 99%

mTOR inhibitors for management of encapsulating peritoneal sclerosis: a review of literatures

2016

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“…This study proposed mTOR inhibitors as an effective option for EPS treatment. 26 Although the more use of tamoxifen in mTOR inhibitors arm can disturb such deduction.…”

Section: Resultsmentioning

confidence: 99%

mTOR inhibitors for management of encapsulating peritoneal sclerosis: a review of literatures

2016

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“…However, the therapeutic dose and duration of treatment is still debatable. mTOR inhibitors are well-known for having antiproliferative effects and have recently been used as medical treatment for ESP after transplantation [9]. The synergistic effects of mTOR inhibitor and tamoxifen have also been reported [10].…”

Section: Discussionmentioning

confidence: 99%

Encapsulating peritoneal sclerosis in liver transplant recipients: a report of 2 cases

et al. 2017

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Encapsulating peritoneal sclerosis (EPS) is a rare cause of intestinal obstruction by a thick fibrous membrane wrapping around the small intestine. It is a possible complication after liver transplantation (LT) that can be fatal. This report describes 2 cases of EPS after LT that were successfully treated with surgery, corticosteroids, tamoxifen, and mammalian target of rapamycin inhibitor. After treatment in both cases, the patients were able to start oral feeding and have been symptom free for more than 1 year. These cases suggests that for the management of EPS, surgical treatment is mandatory when the patients present with symptoms of intestinal obstruction or if there are findings suggestive of decreased mural perfusion. Surgery should be accompanied with medical treatment to prevent the relapse of EPS.

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“…Retrospective studies and registry data suggest that after 10 years on PD, a transplant recipient has a 10% risk of EPS on conventional CNI regimens versus a 1% risk on low dose CNI + mTOR inhibitors. Adaptation of the immunosuppressive protocol toward mTOR inhibitors, MMF, and corticosteroids may be justified in order to prevent post-transplant EPS in patients at high risk [101].…”

Section: Treatment Of Epsmentioning

confidence: 99%

Encapsulating Peritoneal Sclerosis: Pathophysiology and Current Treatment Options

Jagirdar

Bozikas

Zarogiannis

et al. 2019

IJMS

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Encapsulating peritoneal sclerosis (EPS) is a life-threatening complication of long-term peritoneal dialysis (PD), which may even occur after patients have switched to hemodialysis (HD) or undergone kidney transplantation. The incidence of EPS varies across the globe and increases with PD vintage. Causative factors are the chronic exposure to bioincompatible PD solutions, which cause long-term modifications of the peritoneum, a high peritoneal transporter status involving high glucose concentrations, peritonitis episodes, and smoldering peritoneal inflammation. Additional potential causes are predisposing genetic factors and some medications. Clinical symptoms comprise signs of intestinal obstruction and a high peritoneal transporter status with incipient ultrafiltration failure. In radiological, macro-, and microscopic studies, a massively fibrotic and calcified peritoneum enclosed the intestine and parietal wall in such cases. Empirical treatments commonly used are corticosteroids and tamoxifen, which has fibrinolytic properties. Immunosuppressants like azathioprine, mycophenolate mofetil, or mTOR inhibitors may also help with reducing inflammation, fibrin deposition, and collagen synthesis and maturation. In animal studies, N-acetylcysteine, colchicine, rosiglitazone, thalidomide, and renin-angiotensin system (RAS) inhibitors yielded promising results. Surgical treatment has mainly been performed in severe cases of intestinal obstruction, with varying results. Mortality rates are still 25–55% in adults and about 14% in children. To reduce the incidence of EPS and improve the outcome of this devastating complication of chronic PD, vigorous consideration of the risk factors, early diagnosis, and timely discontinuation of PD and therapeutic interventions are mandatory, even though these are merely based on empirical evidence.

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mTOR inhibitors for medical treatment of post-transplantation encapsulating peritoneal sclerosis: a favourable single center experience

Cited by 12 publications

References 37 publications

mTOR inhibitors for management of encapsulating peritoneal sclerosis: a review of literatures

mTOR inhibitors for management of encapsulating peritoneal sclerosis: a review of literatures

Encapsulating peritoneal sclerosis in liver transplant recipients: a report of 2 cases

Encapsulating Peritoneal Sclerosis: Pathophysiology and Current Treatment Options

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