대한신장학회

논문분류	춘계학술대회 초록집
제목	Encapsulating peritoneal sclerosis after renal transplantation : Two cases successfully treated with surgery
저자	Hye Ran Kang*, Si Nae Lee1, Soon Hyo Kwon1, Jin Seok Jeon1, Dong Cheol Han1, Chul Moon2, Yoon Mi Jeen3, Hyunjin Noh1
출판정보	2016; 2016(1):
키워드	Encapsulating peritoneal sclerosis, Renal transplantation
초록	Background: Encapsulating peritoneal sclerosis (EPS) is rare but a serious complication of long-term peritoneal dialysis (PD). Both termination of PD that could lead to diminished clearance of fibrin and transplantation-related factors, for example, calcineurin inhibitors could be associated with EPS after renal transplantation. For treating EPS, there is no established medical treatment and surgery has offered variable results. Although surgical treatment can be performed in patients who do not respond to medical treatment such as total parenteral nutrition (TPN), corticosteroid, and tamoxifen, the prognosis is highly dependent on the surgical technique and surgeon’s skill. Methods: We report two cases of post-transplantation EPS successfully treated with surgery. Results: Both patients were characterized by long duration of PD (173 months and 228 months) and were taking immunosuppressive agents consisted of corticosteroids, tacrolimus, and mycophenolate mofetil. A 54-year-old woman had bowel obstruction symptoms including abdominal pain, nausea, and vomiting at 6 weeks after transplantation. She was managed by medical treatment for 6 weeks using TPN and tamoxifen, but the symptoms were not improved. Another 50-year-old woman developed similar symptoms at 11 months after transplantation. She did not show any improvement with medical treatment for 4 months. They underwent laparotomy via median abdominal incision. The small bowel was encased in a dense white fibrous tissue with calcification and a large amount of ascites was found. Peritonectomy and adhesiolysis from stomach to terminal ileum was successfully performed in both patients. Histological examination revealed dense fibrotic tissue with nonspecific inflammation and calcification. Both patients have survived without complications and were completely relieved from bowel obstruction symptoms and followed for 15 months and 9 months after surgery. Conclusion: We conclude that surgical treatment is a promising therapy for post-transplant EPS.
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