Abstract: SA-PO1183
Encapsulating Peritoneal Sclerosis After Kidney Transplantation: A Diagnostic Challenge
Session Information
- Transplantation: Clinical - Complications, Pediatrics, and Multi-Organ Considerations
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2002 Transplantation: Clinical
Authors
- Su, Lauren, University of Southern California, Los Angeles, California, United States
- Taylor, Joseph, University of Southern California, Los Angeles, California, United States
- Klair, Nathaniel, University of Southern California, Los Angeles, California, United States
- Nguyen, Matthew Duy Thanh Luyen, University of Southern California, Los Angeles, California, United States
- Sharma, Neeraj, University of Southern California, Los Angeles, California, United States
Introduction
Encapsulating peritoneal sclerosis (EPS), also known as sclerosing encapsulating peritonitis or “cocoon abdomen,” is a rare but severe complication of long-term peritoneal dialysis (PD). EPS can progress even after discontinuation of PD and may present after kidney transplantation, often leading to delayed diagnosis due to nonspecific gastrointestinal manifestations.
Case Description
We present the case of a 56-year-old woman with systemic lupus erythematosus complicated by biopsy-proven class IV lupus nephritis leading to end-stage kidney disease, who underwent PD for 10 years prior to deceased donor kidney transplantation in February 2020. Two months following transplantation, she developed persistent abdominal fullness, nausea, vomiting, and weight loss. Initial diagnostic evaluation was unrevealing, including normal gastric emptying study, esophagogastroduodenoscopy, and colonoscopy. Antimetabolite therapy was switched from mycophenolate to azathioprine without symptom improvement. One year later, MRI pelvis performed for evaluation of an adnexal mass incidentally demonstrated diffuse nonspecific peritoneal thickening.
Over the ensuing years, she experienced recurrent abdominal pain and obstructive gastrointestinal symptoms requiring multiple hospitalizations. CT abdomen demonstrated dilated jejunal and ileal loops consistent with bowel obstruction. In September 2024, she presented with high-grade small bowel obstruction, and imaging findings were highly suspicious for encapsulating peritoneal sclerosis.
At the time of diagnosis, the disease was considered advanced. Due to progressive frailty, malnutrition, and overall poor functional status, standard therapeutic interventions were no longer considered viable treatment options.
Discussion
This case illustrates the diagnostic difficulty and delayed recognition of EPS after kidney transplantation. The patient experienced recurrent symptoms for nearly four years before a definitive diagnosis was found, at which time the disease was too advanced to consider standard interventions for EPS, such as surgical enterolysis and/or antifibrotic therapy with tamoxifen. Clinicians should maintain a high index of suspicion for EPS in patients with prolonged PD exposure who develop recurrent obstructive gastrointestinal symptoms after transplantation, as earlier recognition may allow timely intervention and potentially improve outcomes.