Posttransplant Encapsulating Peritoneal Sclerosis: A Worrying New Trend?

Fieren, M. W. J. A.; Betjes, M.; Korte, Mario R.; Boer, Walther H.

doi:10.1177/089686080702700603

Cited by 95 publications

(72 citation statements)

References 17 publications

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“…This latter form is extensively described in Japan, where patients tend to stay on PD longer, because kidney transplantation is limited (10). In contrast, posttransplantation EPS patients tend to be younger when initiating PD and do not necessarily have a prolonged PD duration (13,18). In this study, patients with posttransplantation EPS had a significantly longer PD duration compared to transplanted patients without EPS.…”

Section: Discussionmentioning

confidence: 99%

Posttransplantation Encapsulating Peritoneal Sclerosis Contributes Significantly to Mortality after Kidney Transplantation

Korte

Habib

Lingsma

et al. 2011

American Journal of Transplantation

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Encapsulating peritoneal sclerosis (EPS) is a severe complication of peritoneal dialysis (PD) and may present after kidney transplantation, a condition known as posttransplantation EPS. The prevalence and impact of posttransplantation EPS on survival after kidney transplantation is unknown. From January 1, 1996 until July 1, 2007, 1241 PD patients were transplanted. Thirty-eight cases of posttransplantation EPS (3%) were identified from the Dutch multicenter EPS study. In EPS patients the mean pretransplant dialysis duration was longer than in the controls (71.4 ± 37.5 months vs. 34.7 ± 25.5, p < 0.0001). The majority of EPS cases were observed within the first 2 years after transplantation, but some cases appeared many years after transplantation. Two hundred and one (16.2%) patients died after transplantation, of which 17 were EPS patients. After infection (23.9%), cardiovascular disease (21.9%) and malignancy (10.9%), EPS (8.5%) was the fourth known cause of death after transplantation. Kaplan-Meier analysis showed a significant decreased survival for transplanted patients with posttransplantation EPS compared to transplanted patients without EPS. In conclusion, posttransplantation EPS is rare but carries a high mortality. A prolonged clinical vigilance and a high index of suspicion for the diagnosis are warranted, specifically in PD patients with a relatively long cumulative pretransplant duration of PD.

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Section: Discussionmentioning

confidence: 99%

Posttransplantation Encapsulating Peritoneal Sclerosis Contributes Significantly to Mortality after Kidney Transplantation

Korte

Habib

Lingsma

et al. 2011

American Journal of Transplantation

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“…One of the most noteworthy complications of PD patients is encapsulating peritoneal sclerosis (EPS) resulting from the decreased peritoneal function,10 which sometimes results in adverse outcomes. Renal transplant after PD aggravates EPS because of the elevation of the cytokine release and fibrinogenic changes due to the transplant operation,11 in spite of the administration of immunosuppressive agents which are thought to have preventive and therapeutic effects on EPS. No EPS occurred in the current series; however, EPS is an irreversible disability even after successful renal transplantation.…”

Section: Discussionmentioning

confidence: 99%

Short‐term outcome of renal transplantation treated with pre‐transplant peritoneal dialysis

Kitada

Doi

Nishiki

et al. 2010

Dialysis & Transplantation

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OBJECTIVE Pre‐transplant dialysis has been reported to have an impact on the outcome in renal transplantation; however, it is still controversial. This study evaluated the short‐term outcome of pre‐transplant peritoneal dialysis (PD) in comparison to that of hemodialysis (HD). PATIENTS AND METHODS All living donor kidney transplantations performed from January 2008 to April 2009 were enrolled and divided into 2 groups according to pre‐transplant dialysis, HD and PD. The recipient's age, duration of dialysis, acute rejection episodes, incidence of infection, serum creatinine level, and surgical complications were evaluated. RESULTS The PD group was significantly younger and the duration of their dialysis was shorter. The creatinine level in the PD group was significantly lower than that in the HD group. Acute rejection proven by biopsy was seen in 4 of 36 patients in the HD group and in only 1 of 14 patients in the PD group. There was no difference in the incidence of infection between the 2 groups. There were no vessel complications in any patients, but there were a few urological complications in both groups. Delayed graft function resulting from intractable ascites occurred in 1 patient in the PD group. CONCLUSION Renal transplantation in patients with pre‐transplant PD can be performed safely, although the development of ascites, the timing of removal of the PD catheter, and encapsulating peritoneal sclerosis may occur even after successful transplantation.

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“…24 Several centers have recently reported an increase in the number of cases of EPS in PD patients with a history of renal transplantation. 25,26 As in our case, it is tempting to speculate that EPS may be promoted by the use of calcineurin inhibitors (CNI) coupled with peritoneal injury secondary to exposure to PD fluid and/or infection coupled with a history of recent PD cessation. Animal data suggest that CNI may further propagate the profibrotic and inflammatory processes already established in the visceral peritoneum.…”

Section: Discussionmentioning

confidence: 75%

Encapsulating peritoneal sclerosis: Importance to the hemodialysis practitioner

Perl

Bargman

Chan

2009

Hemodialysis International

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Encapsulating peritoneal sclerosis (EPS) is a rare but devastating complication of long-term peritoneal dialysis (PD) therapy. Encapsulating peritoneal sclerosis is characterized by peritoneal membrane inflammation, followed by progressive peritoneal membrane fibrosis and intestinal encapsulation. Clinical manifestations include ascites as well as intermittent and recurrent small bowel obstruction. The prognosis of EPS is poor. The exact cause of EPS remains unknown. While the risk factors for EPS are not well elucidated, EPS is seen with increased frequency after an increased duration of PD therapy. In more than half the patients who develop EPS, the diagnosis is made after transfer to hemodialysis (HD). It is important for the HD practitioner to initiate surveillance in any patient at risk for EPS while maintaining a heightened index of suspicion for EPS in an HD patient with gastrointestinal symptoms and a history of previous PD therapy. Early diagnosis and prompt initiation of treatment is essential. Early in the course of EPS, immunosuppressive therapy remains the mainstay of treatment. Ultimately, parenteral nutritional support may be required along with surgical therapy to relieve intestinal obstruction. We report a case of EPS in an HD patient at our center highlighting the incidence, risk factors, and treatment strategies in the context of available evidence.

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Posttransplant Encapsulating Peritoneal Sclerosis: A Worrying New Trend?

Cited by 95 publications

References 17 publications

Posttransplantation Encapsulating Peritoneal Sclerosis Contributes Significantly to Mortality after Kidney Transplantation

Posttransplantation Encapsulating Peritoneal Sclerosis Contributes Significantly to Mortality after Kidney Transplantation

Short‐term outcome of renal transplantation treated with pre‐transplant peritoneal dialysis

Encapsulating peritoneal sclerosis: Importance to the hemodialysis practitioner

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