title: m-TOR inhibitors may be useful in the treatment of encapsulating peritoneal sclerosis (EPS).
abstract: Encapsulating peritoneal sclerosis (EPS) is a rare but serious complication of long-term peritoneal dialysis, often occurring after patients have been shifted to haemodialysis or undergone renal transplantation. EPS is still associated with high morbidity and mortality but, although various treatment modalities have been tried, the optimal therapy is still debated. The present paper reports a 16-year-old patient who developed EPS 6 months after shifting to haemodialysis and, following adhesiolysis, was successfully treated with a combination of steroids, tamoxifen and everolimus, this last drug chosen for its antiproliferative effect through mammalian target of rapamycin (mTOR) inhibition and its ability to block vascular endothelial growth factor and neoangiogenesis. EPS progressively improved and the patient successfully underwent renal transplantation 5 years later. The case suggests that, in view of their mechanism of action, mTOR inhibitors should be considered as an immunosuppressive agent after renal transplantation in patients at risk and merit investigation in future trials on this condition.
authors: Nephrology, Dialysis and Renal Transplantation Unit, Ospedali Riuniti, Ancona, Italy, gm.frasca@ospedaliriuniti.marche.it.
authors: Giovanni Maria
authors: GM
authors: Frascà
authors: Mario
authors: M
authors: D'Arezzo
authors: Anna Maria
authors: AM
authors: Ricciatti
authors: Emilio
authors: E
authors: Balestra
authors: Domenica
authors: D
authors: Taruscia
authors: Valentina
authors: V
authors: Nastasi
authors: Gaia
authors: G
authors: Goteri
mesh_terms: D000293:Adolescent; D001706:Biopsy; D000068338:Everolimus; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation; D008297:Male; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D056627:Peritoneal Fibrosis / Q000175:diagnosis / Q000188:drug therapy* / Q000201:enzymology / Q000209:etiology; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use*; D020123:Sirolimus / Q000031:analogs & derivatives* / Q000627:therapeutic use; D058570:TOR Serine-Threonine Kinases / Q000037:antagonists & inhibitors* / Q000378:metabolism; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D047428:Protein Kinase Inhibitors; D000068338:Everolimus; C546842:MTOR protein, human; D058570:TOR Serine-Threonine Kinases; D020123:Sirolimus