A role for everolimus in post-transplant encapsulating peritoneal sclerosis: First case report

Authors

  • Rahul Sud,

    Corresponding author
    1. Renal Unit, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
    • Correspondence:

      Dr Rahul Sud, Renal Unit, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia. Email: rahul_sud@outlook.com

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  • Lorraine Garry,

    1. Transplantation, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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  • Stephen Timothy Spicer,

    1. Renal Unit, Liverpool Hospital, Sydney, New South Wales, Australia
    2. University of New South Wales Medical School, Sydney, New South Wales, Australia
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  • Richard DM Allen,

    1. Transplantation, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
    2. Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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  • Josette M Eris,

    1. Transplantation, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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  • Kate Wyburn,

    1. Transplantation, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
    2. Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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  • Deborah Verran,

    1. Transplantation, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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  • Caroline Louise Cooper,

    1. Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
    2. Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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  • Steve Chadban

    1. Transplantation, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
    2. Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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  • Conflict of interests: Josette M Eris is on the Transplant Advisory Board of Novartis, Jansen Cilag and has received research grants from Novartis, Roche and Pfizer.

Abstract

Encapsulating peritoneal sclerosis (EPS) is a rare complication of peritoneal dialysis (PD) that carries a high morbidity and mortality. The ‘two hit theory’ suggests that long term deterioration of the peritoneum combined with intraperitoneal inflammation is needed in the pathogenesis of EPS. For unclear reasons, post transplantation EPS is being increasingly reported in patients previously on PD. To date, there is no proven effective therapy with an absence of randomised controlled trials. Individual case reports and small case series have reported on the use of tamoxifen and corticosteroids for medical management of EPS. The use of everolimus has been reported in a single case, and never in the setting of renal transplantation. Here, we present the first case of post-transplant encapsulating peritoneal sclerosis treated successfully with a combination of everolimus, tamoxifen, low dose corticosteroid and surgery.

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