m-TOR inhibitors may be useful in the treatment of encapsulating peritoneal sclerosis (EPS)

J Nephrol. 2014 Oct;27(5):587-90. doi: 10.1007/s40620-014-0052-5. Epub 2014 Feb 12.

Abstract

Encapsulating peritoneal sclerosis (EPS) is a rare but serious complication of long-term peritoneal dialysis, often occurring after patients have been shifted to haemodialysis or undergone renal transplantation. EPS is still associated with high morbidity and mortality but, although various treatment modalities have been tried, the optimal therapy is still debated. The present paper reports a 16-year-old patient who developed EPS 6 months after shifting to haemodialysis and, following adhesiolysis, was successfully treated with a combination of steroids, tamoxifen and everolimus, this last drug chosen for its antiproliferative effect through mammalian target of rapamycin (mTOR) inhibition and its ability to block vascular endothelial growth factor and neoangiogenesis. EPS progressively improved and the patient successfully underwent renal transplantation 5 years later. The case suggests that, in view of their mechanism of action, mTOR inhibitors should be considered as an immunosuppressive agent after renal transplantation in patients at risk and merit investigation in future trials on this condition.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Biopsy
  • Everolimus
  • Humans
  • Immunosuppressive Agents / therapeutic use*
  • Kidney Transplantation
  • Male
  • Peritoneal Dialysis / adverse effects*
  • Peritoneal Fibrosis / diagnosis
  • Peritoneal Fibrosis / drug therapy*
  • Peritoneal Fibrosis / enzymology
  • Peritoneal Fibrosis / etiology
  • Protein Kinase Inhibitors / therapeutic use*
  • Sirolimus / analogs & derivatives*
  • Sirolimus / therapeutic use
  • TOR Serine-Threonine Kinases / antagonists & inhibitors*
  • TOR Serine-Threonine Kinases / metabolism
  • Tomography, X-Ray Computed
  • Treatment Outcome

Substances

  • Immunosuppressive Agents
  • Protein Kinase Inhibitors
  • Everolimus
  • MTOR protein, human
  • TOR Serine-Threonine Kinases
  • Sirolimus