Tamoxifen therapy in kidney-transplant patients presenting with severe encapsulating peritoneal sclerosis after treatment for acute humoral rejection

Abstract

Objectives: Encapsulating peritoneal sclerosis is a rare but serious complication in patients undergoing peritoneal dialysis. Its mortality rate is approximately 30%, despite treatment with total parenteral nutrition, surgery, tamoxifen, or immunosuppressants.

Materials and methods: Of 991 kidney transplants performed at our institution over 9 years, 50 patients were treated for chronic peritoneal dialysis at the time of transplant.

Results: Two cases of encapsulating, peritoneal sclerosis occurred in patients receiving pretransplant peritoneal dialysis. Both had received intensive posttransplant treatment for acute humoral rejection. Encapsulating peritoneal sclerosis occurred at 3 months and 4 months after the transplant. Both presented with intestinal pain and gut obstruction. They were given total parenteral nutrition plus tamoxifen (20 mg/d) for 3 months. Outcomes were favorable for 1, though there was no improvement for the second patient, who was then also given sirolimus. He died later from multiorgan failure secondary to digestive-related sepsis, and encapsulating, peritoneal, sclerosis-related symptoms.

Conclusions: When encapsulating, peritoneal sclerosis occurs after kidney transplant, tamoxifen therapy could be implemented.