Surgical treatment of post-transplant encapsulating peritoneal sclerosis: A single-center experience

BACKGROUND: Encapsulating peritoneal sclerosis (EPS) related to peritoneal dialysis (PD) has a vague etiology and high mortality. In this study, our aim was to determine treatment options for EPS cases.
METHODS: A total of 169 patients underwent kidney transplantation from January 2008 to January 2018 and 119 patients from a cadaveric and 50 patients from a living donor. Twenty-one patients were undergoing PD before the transplantation. The mean PD time was 6.9 (IQR 3–14) years. Four patients received surgical treatment for EPS that occurred after the transplant. After the surgical treatment, 2 patients died because of sepsis. Two patients were discharged without complications, but 1 had late-term EPS recurrence.
RESULTS: EPS is a rare but serious complication of long-term PD. It has a high mortality and morbidity rate. Long-term PD is the most significant factor for triggering EPS. Nutritional support and surgical intervention is the next step if medical treatment fails. Resistant cases should be treated surgically without much delay before the condition deteriorates.
CONCLUSION: It can be especially devastating for patients with a long-term PD history to have EPS after a successful transplant. Because EPS is a challenging condition, its management should be done in experienced clinics to decrease its mortality and morbidity rates.

Böbrek nakli sonrasý geliþen enkapsüle periton sklerozunda cerrahi tedavi: Tek merkez deneyimi

AMAÇ: Enkapsüle periton sklerozu (EPS) periton diyalizi (PD) ile iliþkili, etiyolojisi tam bilinmeyen ve yüksek mortaliteye sahip bir hastalýktýr. Bu çalýþmada amacýmýz EPS olgularýnda tedavi seçeneklerini deðerlendirmektir.
GEREÇ VE YÖNTEM: Ocak 2008–2018 tarihleri arasýnda 169 hastaya böbrek nakli yapýldý. Yüz on dokuzu kadavradan, 50’si canlý donörden nakil yapýldý. Yirmi bir hasta nakil öncesi PD yapmaktaydý. Ortalama PD süresi 6.9 (3–14) yýl idi. Dört hastaya nakil sonrasý geliþen EPS nedeni ile cerrahi tedavi uygulandý. Cerrahi tedavi sonrasý, iki hasta sepsis nedeni ile kaybedildi. Ýki hasta komplikasyonsuz taburcu edildi, ancak birinde geç dönem EPS nüksü geliþti.
BULGULAR: Enkapsüle periton sklerozu uzun süreli PD’nin nadir fakat ciddi bir komplikasyonudur. Mortalite ve mortalite oraný yüksektir. Uzun süreli PD, EPS’yi tetiklemede en önemli faktördür. Týbbi tedavi ve beslenme desteði baþarýsýz olursa, cerrahi müdahale sonraki adýmdýr. Týbbi tedaviye dirençli olgularda hastanýn genel durumu bozulmadan ve gecikmeden cerrahi tedavi yapýlmalýdýr.
TARTIÞMA: Uzun süreli PD öyküsü olan hastalarýn baþarýlý bir nakil sonrasý EPS olmasý özellikle yýkýcý olabilir. Zor bir durum olarak, mortalite ve morbidite oranlarýný azaltmak için EPS yönetimi deneyimli kliniklerde yapýlmalýdýr.