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.

• Authors: Abdellatif Ould Mohamed, Nassim Kamar, Marie-Béatrice Nogier, Laure Esposito, Jean Pierre Duffas, Lionel Rostaing
• Journal: Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation (Exp Clin Transplant) Vol. 7 Issue 3 Pg. 164-7 (Sep 2009) ISSN: 2146-8427 [Electronic] Turkey
• PMID: 19715526 (Publication Type: Case Reports, Journal Article)

Chemical References

• Immunosuppressive Agents
• Tamoxifen

Topics

• Acute Disease
• Adult
• Combined Modality Therapy
• Drug Therapy, Combination
• Fatal Outcome
• Graft Rejection (immunology, therapy)
• Humans
• Immunity, Humoral (drug effects)
• Immunosuppressive Agents (therapeutic use)
• Kidney Transplantation (adverse effects)
• Male
• Middle Aged
• Multiple Organ Failure (etiology)
• Parenteral Nutrition, Total
• Peritoneal Dialysis, Continuous Ambulatory (adverse effects)
• Peritoneal Fibrosis (drug therapy, etiology)
• Plasmapheresis
• Severity of Illness Index
• Tamoxifen (therapeutic use)
• Treatment Outcome