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POSTTRANSPLANT ENCAPSULATING PERITONEAL SCLEROSIS: A WORRYING NEW TREND?

Nephrology,¹ Department of Internal Medicine, Erasmus Medical Center, Rotterdam; Department of Nephrology,² University Medical Center, Utrecht, The Netherlands

Correspondence to: M.W.J.A. Fieren, Erasmus Medical Center, Room Bd 336, Post office Box 2040, 3000CA Rotterdam, The Netherlands. m.fieren{at}erasmusmc.nl

Encapsulating peritoneal sclerosis (EPS) is a rare but serious complication in patients on peritoneal dialysis (PD). We describe a cluster of 13 EPS cases occurring in 2 university hospitals in The Netherlands. Most of these cases were diagnosed after recent kidney transplantation, when the patients developed severe symptoms of bowel obstruction. This accumulation raised the question as to whether other than known risk factors, such as duration of PD treatment, could be involved in the development or course of EPS after transplantation. According to various publications, EPS has been diagnosed often after withdrawal from PD, suggesting that cessation in itself may be a risk factor. In addition, transplantation-related management should be considered to play a role, including the use of the profibrotic calcineurin inhibitors and the trend to reduce the load of corticosteroids in treatment regimes. To identify risk factors, further multicenter studies are required, paying special attention to alterations in immunosuppressive treatment regimens as well as PD prescriptions, including PD fluid characteristics. Transfer from PD to hemodialysis should be under serious consideration in patients eligible for kidney transplantation as soon as there are indications of ultrafiltration failure.

KEY WORDS: Encapsulating peritoneal sclerosis; kidney transplantation; immunosuppressives; ultrafiltration failure.

Received 13 October 2006; accepted 20 July 2007.

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