title: mTOR inhibitors for medical treatment of post-transplantation encapsulating peritoneal sclerosis: a favourable single center experience.
abstract: BACKGROUND
  Encapsulating peritoneal sclerosis (EPS) is a serious complication in patients on peritoneal dialysis (PD) causing intestinal obstruction. Two different forms of EPS are reported: the classical one observed in patients on PD, and post-transplantation EPS (PostTx-EPS). The first-line therapy of classical and PostTx-EPS remains surgical treatment, but for both the complication rate and mortality are high. Recently, a few cases of EPS were successfully treated with inhibitors of mammalian target of rapamycin (mTORi). The aim of this study was to evaluate PostTx-EPS outcome in our patients, focusing on the potential benefit of mTORi treatment.
  
  
  METHODS
  We performed a retrospective analysis on 1,048 kidney transplanted patients at our center between 11/2001 and 12/2011.
  
  
  RESULTS
  In the 226 patients treated with PD at any time before grafting, we found 10 cases of PostTx-EPS (prevalence 4.4%). The mean age was 54.9 years (26-69), with a mean time on PD of 83.1 months (33-156). The interval between kidney transplant and EPS diagnosis was 10.5 months (4-18.9). Five of the ten patients were treated after the diagnosis with mTORi, with a favorable outcome in 4/5 cases. This result was substantially independent of surgical and steroid therapy, performed in 9/10 and 10/10 patients respectively.
  
  
  CONCLUSIONS
  EPS is a serious complication but susceptible to improvement if early diagnosed. mTORi represent a useful option for EPS treatment. We too suggest adopting an immunosuppressive protocol based on mTORi, mycophenolate mofetil and steroids in order to prevent PostTx-EPS in transplanted patients at high risk.
authors.affiliation: Renal Transplantation Unit "A. Vercellone", Division of Nephrology Dialysis and Transplantation, Department of Medical Sciences, Città della Salute e della Scienza Hospital and University of Torino, Corso Bramante, 88-10126, Turin, Italy, mmessina@cittadellasalute.to.it.
authors.forename: Maria
authors.initials: M
authors.lastname: Messina
authors.forename: Claudia
authors.initials: C
authors.lastname: Ariaudo
authors.forename: Alberto
authors.initials: A
authors.lastname: Mella
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Cantaluppi
authors.forename: Giuseppe P
authors.initials: GP
authors.lastname: Segoloni
authors.forename: Luigi
authors.initials: L
authors.lastname: Biancone
mesh_terms: D000328:Adult; D000368:Aged; D000068338:Everolimus / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007676:Kidney Failure, Chronic / Q000628:therapy; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects; D056627:Peritoneal Fibrosis / Q000188:drug therapy* / Q000209:etiology; D012189:Retrospective Studies; D020123:Sirolimus / Q000627:therapeutic use*; D013256:Steroids / Q000627:therapeutic use; D058570:TOR Serine-Threonine Kinases / Q000037:antagonists & inhibitors*; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D013256:Steroids; D000068338:Everolimus; C546842:MTOR protein, human; D058570:TOR Serine-Threonine Kinases; D020123:Sirolimus