EPS, a severe complication of PD and may present after kidney txp upon discontinuation of PD, a condition known as post-transplantation EPS. TDespite the possible positive effect of immunosuppression on EPS, successful treatment remains obscure.

Aims

1. Prevalence of post renal txp EPS in our cohort of patients on PD who received a kidney transplant

2. Outcomes in post-transplant EPS treated with increased dose of corticosteroids and tamoxifen

Methods

retrospective analysis of all tx pts between 2006-2017 with EPS post-transplant. paper and electronic records were analyzed & demographic, clinical and laboratory data was collected for all identified patients. EPS was diagnosed by clinical and radiological criteria.

Results

938 kidney transplants between 2006-2017 , 200 pts had exposure to PD prior to transplant . 8 (4%) developed EPS post-transplantation. The mean age of patients was 47 years and 50% were male The mean duration of PD in these patients was 7 years and . 6 patients had two or more peritonitis episodes on PD. Six patients had exposure to icodextrin.. EPS was diagnosed at a median time of 7 mths(2-36) post-txp . 3 presented with symptoms of small bowel obstruction & 4 with resistant/bloody ascites . CT was done in all patients and the most common findings were peritoneal thicking and cocooning of the bowel. The dose of corticosteroids was increased to 1 mg/kg for a month with subsequent slow taper & tamoxifen 20 mg daily was added. The time of improvement of symptoms was approximately 3 months after starting therapy. There was no mortality in this cohort post EPS. 3 patients required surgery for bowel obstruction . The tamoxifen was discontinued in 3 patients at 2 2 years post EPS, and 5 years for 1 patient . The remaining 5 patients remain on tamoxifen. Interestingly 3 of these patients had upper extremity DVT not related to tamoxifen therapy. There was no higher incidence of infections after starting on tamoxifen. No episodes of acute rejection developed after treatment of EPS and all patients continue to have stable graft function.

Conclusions

Pts who developed post transplantation EPS have better outcomes than previously reported. Increased corticosteroid dose and addition of tamoxifen led to the resolution of symptoms in all patients with no increased adverse events. There was no mortality.

CITATION INFORMATION: Parthasarathy R., Fairhead T., McCormick B., Knoll G., Hoar S. Outcomes of Transplant Patients with Encapsulating Peritoneal Sclerosis(EPS) Treated with Tamoxifen and Steroids Am J Transplant. 2017;17 (suppl 3).

« Back to 2018 American Transplant Congress