Background: Encapsulating peritoneal sclerosis (EPS) may occur after kidney transplantation (post-transplantation EPS) or may be diagnosed during or after peritoneal dialysis treatment (classical EPS). The aim of the present study was to investigate to what extent both EPS entities differ in clinical presentation, radiological findings, outcome, and the systemic inflammatory response, as measured by plasma C-reactive protein (CRP) levels both prior to and after EPS diagnosis. Methods: We performed a retrospective analysis of 15 post-transplantation EPS and 19 classical EPS patients who were diagnosed at seven hospitals in the Netherlands between January 1, 2000, and January 1, 2011. Results: There were no inter-group differences in age, duration of peritoneal dialysis, clinical presentation, or radiology findings at diagnosis. Post-transplantation patients had experienced a lower number of peritonitis episodes per patient-year (0.2 (0.0-0.4) vs. 0.7 (0.3-1.2), p = 0.01) with a longer interval between the last peritonitis and EPS diagnosis (18.1 (4.6-34.3) vs. 4.4 (0.89-13.78) months, p = 0.01). Post-transplantation EPS patients showed a remarkably lower mortality rate (40.0 vs. 84.2%, p < 0.05). In both groups a pattern of elevated CRP values was observed, increasing within the year before EPS diagnosis. In the post-transplantation group the median CRP level at diagnosis was lower (56.0 vs. 144.50 mg/l, p < 0.05) than in the classical EPS group. Conclusion: Post-transplantation EPS has a similar clinical presentation as classical EPS but with a lower systemic inflammatory response and better outcome.

Summers AM, Clancy MJ, Syed F, et al: Single-center experience of encapsulating peritoneal sclerosis in patients on peritoneal dialysis for end-stage renal failure. Kidney Int 2005;68:2381-2388.
Honda K, Oda H: Pathology of encapsulating peritoneal sclerosis. Perit Dial Int 2005;25(suppl 4):S19-S29.
Kirkman MA, Heap S, Mitu-Pretorian OM, et al: Posttransplant encapsulating peritoneal sclerosis localized to the terminal ileum. Perit Dial Int 2010;30:480-482.
Kawanishi H, Kawaguchi Y, Fukui H, et al: Encapsulating peritoneal sclerosis in Japan: a prospective, controlled, multicenter study. Am J Kidney Dis 2004;44:729-737.
Kawanishi H, Harada Y, Noriyuki T, et al: Treatment options for encapsulating peritoneal sclerosis based on progressive stage. Adv Perit Dial 2001;17:200-204.
Johnson DW, Cho Y, Livingston BE, et al: Encapsulating peritoneal sclerosis: incidence, predictors, and outcomes. Kidney Int 2010;77:904-912.
Phelan PJ, Walshe JJ, Al-Aradi A, et al: Encapsulating peritoneal sclerosis: experience of a tertiary referral center. Ren Fail 2010;32:459-463.
Korte MR, Sampimon DE, Lingsma HF, et al: Risk factors associated with encapsulating peritoneal sclerosis in Dutch EPS study. Perit Dial Int 2011;31:269-278.
Nakayama M: The plasma leak-to-response hypothesis: a working hypothesis on the pathogenesis of encapsulating peritoneal sclerosis after long-term peritoneal dialysis treatment. Perit Dial Int 2005;25(suppl 4):S71-S76.
Honda K, Nitta K, Horita S, et al: Histologic criteria for diagnosing encapsulating peritoneal sclerosis in continuous ambulatory peritoneal dialysis patients. Adv Perit Dial 2003;19:169-175.
Dejagere T, Evenepoel P, Claes K, Kuypers D, Maes B, Vanrenterghem Y: Acute-onset, steroid-sensitive, encapsulating peritoneal sclerosis in a renal transplant recipient. Am J Kidney Dis 2005;45:e33-e37.
Kuriyama S, Tomonari H: Corticosteroid therapy in encapsulating peritoneal sclerosis. Nephrol Dial Transplant 2001;16:1304-1305.
Mori Y, Matsuo S, Sutoh H, Toriyama T, Kawahara H, Hotta N: A case of a dialysis patient with sclerosing peritonitis successfully treated with corticosteroid therapy alone. Am J Kidney Dis 1997;30:275-278.
Eltoum MA, Wright S, Atchley J, Mason JC: Four consecutive cases of peritoneal dialysis-related encapsulating peritoneal sclerosis treated successfully with tamoxifen. Perit Dial Int 2006;26:203-206.
Allaria PM, Giangrande A, Gandini E, Pisoni IB: Continuous ambulatory peritoneal dialysis and sclerosing encapsulating peritonitis: tamoxifen as a new therapeutic agent? J Nephrol 1999;12:395-397.
Balasubramaniam G, Brown EA, Davenport A, et al: The Pan-Thames EPS study: treatment and outcomes of encapsulating peritoneal sclerosis. Nephrol Dial Transplant 2009;24:3209-3215.
Hendriks PM, Ho-dac-Pannekeet MM, van Gulik TM, et al: Peritoneal sclerosis in chronic peritoneal dialysis patients: analysis of clinical presentation, risk factors, and peritoneal transport kinetics. Perit Dial Int 1997;17:136-143.
Moustafellos P, Hadjianastassiou V, Roy D, et al: Tamoxifen therapy in encapsulating sclerosing peritonitis in patients after kidney transplantation. Transplant Proc 2006;38:2913-2914.
Hendriks MP, de Sevaux RG, Hilbrands LB: Encapsulating peritoneal sclerosis in patients on peritoneal dialysis. Neth J Med 2008;66:269-274.
Goodlad C, Tarzi R, Gedroyc W, Lim A, Mo-ser S, Brown EA: Screening for encapsulating peritoneal sclerosis in patients on peritoneal dialysis: role of CT scanning. Nephrol Dial Transplant 2011;26:1374-1379.
Machado DJ, Cocuzza CS, Nahas WC, Ianhez LE: Sclerosing encapsulating peritonitis after renal transplantation. Does it make sense? Perit Dial Int 2000;20:341-343.
Mohamed AO, Kamar N, Nogier MB, Esposito L, Duffas JP, Rostaing L: Tamoxifen therapy in kidney-transplant patients presenting with severe encapsulating peritoneal sclerosis after treatment for acute humoral rejection. Exp Clin Transplant 2009;7:164-167.
Temple S, Zaltzman J, Perl J: Development of encapsulating peritoneal sclerosis in a renal transplant recipient on sirolimus immunotherapy. Perit Dial Int 2010;30:475-477.
Korte MR, Habib SM, Lingsma H, Weimar W, Betjes MG: Posttransplantation encapsulating peritoneal sclerosis contributes significantly to mortality after kidney transplantation. Am J Transplant 2011;11:599-605.
Korte MR, Yo M, Betjes MG, et al: Increasing incidence of severe encapsulating peritoneal sclerosis after kidney transplantation. Nephrol Dial Transplant 2007;22:2412-2414.
Kawaguchi Y, Kawanishi H, Mujais S, Topley N, Oreopoulos DG: Encapsulating peritoneal sclerosis: definition, etiology, diagnosis, and treatment. International Society for Peritoneal Dialysis Ad Hoc Committee on Ultrafiltration Management in Peritoneal Dialysis. Perit Dial Int 2000;20(suppl 4):S43-S55.
Mujais S, Nolph K, Gokal R, et al: Evaluation and management of ultrafiltration problems in peritoneal dialysis. International Society for Peritoneal Dialysis Ad Hoc Committee on Ultrafiltration Management in Peritoneal Dialysis. Perit Dial Int 2000;20(suppl 4):S5-S21.
Tarzi RM, Lim A, Moser S, et al: Assessing the validity of an abdominal CT scoring system in the diagnosis of encapsulating peritoneal sclerosis. Clin J Am Soc Nephrol 2008;3:1702-1710.
Vlijm A, Stoker J, Bipat S, et al: Computed tomographic findings characteristic for encapsulating peritoneal sclerosis: a case-control study. Perit Dial Int 2009;29:517-522.
Korte MR, Sampimon DE, Betjes MG, Kre-diet RT: Encapsulating peritoneal sclerosis: the state of affairs. Nat Rev Nephrol 2011;7:528-538.
Kawanishi H: Surgical treatment for encapsulating peritoneal sclerosis. Adv Perit Dial 2002;18:139-143.
Pepys MB, Hirschfield GM: C-reactive protein: a critical update. J Clin Invest 2003;111:1805-1812.
Sampimon DE, Korte MR, Barreto DL, et al: Early diagnostic markers for encapsulating peritoneal sclerosis: a case-control study. Perit Dial Int 2010;30:163-169.
Kawanishi H, Shintaku S, Shishida M, Morrishi M, Tsuchiya S, Dohi K: A case of encapsulating peritoneal sclerosis suspected to result from the use of icodextrin peritoneal solution. Adv Perit Dial 2009;25:45-49.
Yamamoto R, Otsuka Y, Nakayama M, et al: Risk factors for encapsulating peritoneal sclerosis in patients who have experienced peritoneal dialysis treatment. Clin Exp Nephrol 2005;9:148-152.
Trigka K, Dousdampanis P, Chu M, et al: Encapsulating peritoneal sclerosis: a single-center experience and review of the literature. Int Urol Nephrol 2011;43:519-526.
Nakamoto H, Kawaguchi Y, Suzuki H: Encapsulating peritoneal sclerosis in patients undergoing continuous ambulatory peritoneal dialysis in Japan. Adv Perit Dial 2002;18:119-123.
Brown MC, Simpson K, Kerssens JJ, Mactier RA: Encapsulating peritoneal sclerosis in the new millennium: a national cohort study. Clin J Am Soc Nephrol 2009;4:1222-1229.
Betjes MG, Langerak AW, van der Spek A, de Wit EA, Litjens NH: Premature aging of circulating T cells in patients with end-stage renal disease. Kidney Int 2011;80:208-217.
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