title: mTOR inhibitors for management of encapsulating peritoneal sclerosis: a review of literatures.
abstract: BACKGROUND
  Encapsulating peritoneal sclerosis (EPS) is an infrequent, serious complication of peritoneal dialysis (PD). EPS may develop after kidney transplantation of PD-treated patients possibly due to the fibrotic effect of calcineurin inhibitors (CNIs). Some experimental and clinical studies proposed inhibitors of mammalian target of rapamycin (mTOR) for EPS management due to their anti-fibrotic and anti-angiogenesis effects. This review evaluated the therapeutic role of mTOR inhibitors in the management of EPS.
  
  
  METHODS
  Thirteen case reports/series consisted of 20 patients (16 post-transplant and four post-hemodialysis EPS cases) were evaluated. We tried to extract the effect of mTOR inhibitors according to authors' conclusion and the time of improvement of patients' symptoms and each treatment modality such as surgery, parenteral nutrition, tamoxifen and mTOR inhibitors.
  
  
  RESULTS
  Of 20 patients, clinical improvement of five patients (25%) is more attributable to mTOR inhibitor therapy. All these five patients were post-kidney transplant EPS cases. Therefore, EPS improvement rate in post-transplant EPS patients was 31.25% (5 of 16 patients). Death after EPS diagnosis occurred in two of seven patients with continued CNIs therapy (28.57%) and 1 of 11 cases (9.09%) who didn't receive CNIs after EPS diagnosis.
  
  
  CONCLUSIONS
  Although the therapeutic effect of mTOR inhibitors against EPS remains unproven, it seems that for patients with post kidney transplant EPS who do not have any contraindication for mTOR inhibitor administration, converting from CNIs to mTOR inhibitors in addition to other EPS treatments may result in improving EPS in approximately one-third of patients and decreasing patients' mortality.
authors.affiliation: a Liver Transplantation Research Center, Tehran University of Medical Sciences , Tehran , Iran.
authors.forename: Maryam
authors.initials: M
authors.lastname: Ghadimi
authors.affiliation: b Nephrology Research Center, Tehran University of Medical Sciences , Tehran , Iran.|c Faculty of Pharmacy , Tehran University of Medical Sciences , Tehran , Iran.
authors.forename: Simin
authors.initials: S
authors.lastname: Dashti-Khavidaki
authors.affiliation: c Faculty of Pharmacy , Tehran University of Medical Sciences , Tehran , Iran.
authors.forename: Hossein
authors.initials: H
authors.lastname: Khalili
mesh_terms: D065095:Calcineurin Inhibitors / Q000009:adverse effects; D000068338:Everolimus / Q000627:therapeutic use*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000009:adverse effects*; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D056627:Peritoneal Fibrosis / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D020123:Sirolimus / Q000627:therapeutic use*; D058570:TOR Serine-Threonine Kinases / Q000037:antagonists & inhibitors*
chemical_list: D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D000068338:Everolimus; C546842:MTOR protein, human; D058570:TOR Serine-Threonine Kinases; D020123:Sirolimus
keywords: Encapsulating peritoneal sclerosis; everolimus; kidney transplantation; mTOR inhibitors; sirolimus