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Abstract: PO2515

A Devastating Complication of Encapsulating Peritoneal Sclerosis (EPS) In Two Renal Transplant Recipients

Session Information

Category: Trainee Case Report

  • 1902 Transplantation: Clinical

Authors

  • Lawson, Benjamin, Los Angeles County Harbor-UCLA Medical Center, Torrance, California, United States
  • Chan, Zar, Los Angeles County Harbor-UCLA Medical Center, Torrance, California, United States
  • Barba, Lilly M., Los Angeles County Harbor-UCLA Medical Center, Torrance, California, United States

Group or Team Name

  • Renal Transplant Program
Introduction

EPS is a rare complication of peritoneal dialysis (PD) which carries great morbidity and mortality. The risk of EPS may be higher in PD patients who undergo renal transplantation as compared to PD patients who do not received a transplant. Pre-transplant EPS, progressive peritoneal remodeling, cessation of PD and use of calcineurin inhibitors are potential etiologies. We present two unique cases of post-transplant EPS requiring surgical intervention with devastating outcomes.

Case Description

Case #1 A 47-year-old female with end stage renal disease due to congenital kidney disease on PD for 8 years transitioned to hemodialysis due to peritonitis, underwent a deceased donor kidney transplant (DDRT) presented 4 weeks post operatively with nausea, vomiting, and abdominal pain. Imaging showed dilated loops of small bowel concerning for partial small bowel obstruction treated non-operatively with bowel rest. One month later she presented with similar symptoms and small bowel obstruction. Due to failure to improve, she was taken to surgery and was found to have a frozen abdomen with dense adhesions. Lysis of adhesions was complicated by enterotomies and small bowel resection. Multiple enterocutaneous fistulas prohibited wound closure. She is being evaluated for a small bowel transplant and remains on parenteral nutritional support. Case #2 A 39-year-old African female with history of ESRD secondary to Lupus on PD for 11 years received a DDRT. Eighteen months post-transplant, she presented with nausea, vomiting and abdominal pain. Imaging showed a small bowel obstruction treated non-operatively with bowel rest. Three weeks later she required emergent surgery for an acute abdomen undergoing lysis of adhesions, bowel resection and end ileostomy. She required parental nutrition for five months.

Discussion

We report two cases of EPS after DDRT who required surgical intervention with devastating outcomes. Fluid and nutritional support have complicated management and affected quality of life. Given the multifactorial etiologies and potential devastating outcomes of EPS, the pre-transplant evaluation should include a detailed assessment. Furthermore, long term PD patients and those with a history peritonitis should be monitored closely post-transplant.