A case of encapsulating peritoneal sclerosis presented shortly after renal transplantation

Abstract

Encapsulating peritoneal sclerosis (EPS) is a rare but serious complication of peritoneal dialysis (PD), characterized by extensive intraperitoneal fibrosis and encasement of bowel loops. It typically associates with long-term PD and progressive loss of ultrafiltration. The management of EPS has evolved substantially from the original report of this entity and now includes immunosuppressive agents, antifibrotic agents, nutritional support, and surgical intervention. Although the exact cause of this condition remains obscure and despite the possible positive effect of immunosuppression on EPS, it has been described in the post-transplant setting upon the discontinuation of PD. We report such a case of a former PD patient who presented with EPS a month after renal transplantation. This article will highlight the current views regarding the management of post-transplant EPS and introduce the problem of long-term PD patients on the deceased-donor transplant waiting list.

Encapsulating Peritoneal Sclerosis: Pathophysiology and Current Treatment Options

“…Chronic uremia associated pro-inflammatory and oxidative stress may further accelerate these pathomechanisms. Distinct peritoneal inflammatory changes and slight peritoneal thickening can already be observed in patients with CKD stage 5 [3] and in patients on hemodialysis, respectively [32,36]. Improvement of the manufacturing process, i.e., the introduction of double chamber PD fluids, separating the glucose at a very low pH from the buffer compound, significantly reduced the fluid GDP content and allowed for the introduction of a physiological buffer, namely bicarbonate.…”

“…Calcineurin inhibitors (CNIs) like tacrolimus and cyclosporin have a profibrotic effect through the up-regulation of TGF-β1 and other profibrogenic factors, and may promote peritoneal matrix accumulation [36,74]. In experimental rat models, cyclosporin combined with prolonged peritoneal exposure to dialysis solutions was related to increased peritoneal fibrosis and angiogenesis [75].…”