Posttransplant Encapsulating Peritoneal Sclerosis, Long-Term Success With Everolimus and Low-Dose CNI: A Case Report

• Published in: Transplantation proceedings Vol. 46; no. 7; pp. 2368 - 2370
• Main Authors: Romagnoli, J, Pedroso, J.A, Paola Salerno, M, Favi, E, Spagnoletti, G, Citterio, F
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2014
• Subjects: Adult; Calcineurin Inhibitors - administration & dosage; Cyclosporine - administration & dosage; Drug Therapy, Combination; Everolimus; Female; Glucocorticoids - administration & dosage; Humans; Immunosuppressive Agents - therapeutic use; Intestinal Obstruction - etiology; Kidney Transplantation; Peritoneal Dialysis; Peritoneal Fibrosis - complications; Peritoneal Fibrosis - drug therapy; Prednisone - administration & dosage; Sirolimus - analogs & derivatives; Sirolimus - therapeutic use; Surgery
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2014.07.060

Abstract Encapsulating peritoneal sclerosis is a serious complication of peritoneal dialysis and can occur even after transplant. The gut is partially or totally enveloped by a thick fibrous membrane that leads to the formation of multiple sections containing intestinal loops contracted and reduced in volume. Exacerbation after renal transplantation is a very rare but sometimes dramatic condition. We report a patient who developed intestinal obstruction due to encapsulating peritoneal sclerosis 1 year after a deceased-donor kidney transplant. Treatment included laparotomy, small-bowel lengthening by release of adhesions, and high doses of corticosteroids. The patient received immunosuppressive therapy with a combination of low-dose cyclosporine, everolimus, and prednisone, unchanged except for a temporary steroid increase in the postoperative period. We report success with this combined surgical plus medical therapy, with no recurrence after 81 months of follow-up.