title: Posttransplant encapsulating peritoneal sclerosis, long-term success with everolimus and low-dose CNI: a case report.
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.
authors.affiliation: Renal Transplant Unit, Department of Surgery, Policlinico Agostino Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: J
authors.initials: J
authors.lastname: Romagnoli
authors.affiliation: Renal Transplant Unit, Department of Surgery, Policlinico Agostino Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: J A
authors.initials: JA
authors.lastname: Pedroso
authors.affiliation: Renal Transplant Unit, Department of Surgery, Policlinico Agostino Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy. Electronic address: mariapaolasalerno@yahoo.it.
authors.forename: M Paola
authors.initials: MP
authors.lastname: Salerno
authors.affiliation: Renal Transplant Unit, Department of Surgery, Policlinico Agostino Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Favi
authors.affiliation: Renal Transplant Unit, Department of Surgery, Policlinico Agostino Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Spagnoletti
authors.affiliation: Renal Transplant Unit, Department of Surgery, Policlinico Agostino Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Citterio
mesh_terms: D000328:Adult; D065095:Calcineurin Inhibitors / Q000008:administration & dosage*; D016572:Cyclosporine / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D000068338:Everolimus; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007415:Intestinal Obstruction / Q000209:etiology; D016030:Kidney Transplantation; D010530:Peritoneal Dialysis; D056627:Peritoneal Fibrosis / Q000150:complications / Q000188:drug therapy*; D011241:Prednisone / Q000008:administration & dosage; D020123:Sirolimus / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D065095:Calcineurin Inhibitors; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D000068338:Everolimus; D011241:Prednisone; D020123:Sirolimus