title: Histological and clinical findings in patients with post-transplantation and classical encapsulating peritoneal sclerosis: a European multicenter study.
abstract: BACKGROUND
  Encapsulating peritoneal sclerosis (EPS) commonly presents after peritoneal dialysis has been stopped, either post-transplantation (PT-EPS) or after switching to hemodialysis (classical EPS, cEPS). The aim of the present study was to investigate whether PT-EPS and cEPS differ in morphology and clinical course.
  
  
  METHODS
  In this European multicenter study we included fifty-six EPS patients, retrospectively paired-matched for peritoneal dialysis (PD) duration. Twenty-eight patients developed EPS after renal transplantation, whereas the other twenty-eight patients were classical EPS patients. Demographic data, PD details, and course of disease were documented. Peritoneal biopsies of all patients were investigated using histological criteria.
  
  
  RESULTS
  Eighteen patients from the Netherlands and thirty-eight patients from Germany were included. Time on PD was 78(64-95) in the PT-EPS and 72(50-89) months in the cEPS group (p>0.05). There were no significant differences between the morphological findings of cEPS and PT-EPS. Podoplanin positive cells were a prominent feature in both groups, but with a similar distribution of the podoplanin patterns. Time between cessation of PD to the clinical diagnosis of EPS was significantly shorter in the PT-EPS group as compared to cEPS (4(2-9) months versus 23(7-24) months, p<0.001). Peritonitis rate was significantly higher in cEPS.
  
  
  CONCLUSIONS
  In peritoneal biopsies PT-EPS and cEPS are not distinguishable by histomorphology and immunohistochemistry, which argues against different entities. The critical phase for PT-EPS is during the first year after transplantation and therefore earlier after PD cessation then in cEPS.
authors.affiliation: Department of Internal Medicine, Division of Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany.
authors.forename: Joerg
authors.initials: J
authors.lastname: Latus
authors.affiliation: Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Sayed M
authors.initials: SM
authors.lastname: Habib
authors.affiliation: Department of Internal Medicine, Division of Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Kitterer
authors.affiliation: Department of Internal Medicine, Division of Nephrology, Albert Schweitzer Hospital, Dordrecht, The Netherlands.
authors.forename: Mario R
authors.initials: MR
authors.lastname: Korte
authors.affiliation: Department of General, Visceral and Trauma Surgery, Robert-Bosch-Hospital, Stuttgart, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Ulmer
authors.affiliation: Department of Diagnostic Medicine, Division of Pathology, Robert-Bosch Hospital, Stuttgart, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Fritz
authors.affiliation: Institute for Science and Technology in Medicine, Keele University, Keele, United Kingdom.
authors.forename: Simon
authors.initials: S
authors.lastname: Davies
authors.affiliation: Department of Nephrology, University Hospital of North Staffordshire, Stoke-on-Trent, United Kingdom.
authors.forename: Mark
authors.initials: M
authors.lastname: Lambie
authors.affiliation: Department of Internal Medicine, Division of Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany.
authors.forename: M Dominik
authors.initials: MD
authors.lastname: Alscher
authors.affiliation: Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Michiel G H
authors.initials: MG
authors.lastname: Betjes
authors.affiliation: Division of Nephrology, University Hospital, Zurich, Switzerland.
authors.forename: Stephan
authors.initials: S
authors.lastname: Segerer
authors.affiliation: Department of Internal Medicine, Division of Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany.
authors.forename: Niko
authors.initials: N
authors.lastname: Braun
mesh_terms: D005060:Europe; D005260:Female; D005858:Germany; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects; D008297:Male; D008562:Membrane Glycoproteins / Q000378:metabolism; D008875:Middle Aged; D009426:Netherlands; D056627:Peritoneal Fibrosis / Q000453:epidemiology* / Q000209:etiology* / Q000473:pathology; D006435:Renal Dialysis / Q000009:adverse effects* / Q000145:classification; D012189:Retrospective Studies; D000098853:Podoplanin
chemical_list: D008562:Membrane Glycoproteins; C117468:PDPN protein, human; D000098853:Podoplanin