Abrahams Alferso C, van Gelder Maaike K, van der Veer Jan Willem, de Jong Pim A, van Leeuwen Maarten S, Boer Walther H
Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands.
Perit Dial Int. 2017 Jul-Aug;37(4):443-450. doi: 10.3747/pdi.2016.00238.
Encapsulating peritoneal sclerosis (EPS) is the most severe complication of peritoneal dialysis (PD). Several retrospective reports published between 2007 and 2009 have suggested an increasing incidence of EPS occurring after kidney transplantation. We conducted a prospective observational study to determine the incidence of post-transplantation EPS and identify possible risk factors.
Consecutive PD patients undergoing kidney transplantation between 2009 and 2013 were included. Encapsulating peritoneal sclerosis was defined as gastrointestinal obstruction combined with radiological evidence of EPS. Gastrointestinal symptoms were assessed using a self-administered Gastrointestinal Symptom Rating Scale (GSRS) questionnaire. Abdominal computed tomography (CT) was performed prospectively at 6 and 18 months post-transplantation. The primary end point was EPS during follow-up.
Fifty-three PD patients were included (age 51 ± 14 years). Mean PD duration was 31.3 months. Peritoneal dialysis solutions low in glucose degradation products and icodextrin were used by 86.8% of patients. A fast or average-fast transport status was documented in 83.0%. After a median follow-up of 19 months, complete data of 47 patients were available for analysis. None of the patients developed clinical or radiological signs of EPS. The GSRS score improved from 1.87 to 1.55 ( = 0.024) and body weight increased from 75.9 to 78.3 kg ( = 0.003). Only 1 patient had new onset localized (< 20%) peritoneal thickening on CT 22 months post-transplantation.
Post-transplantation EPS did not develop in this cohort of patients with a relatively short time of PD exposure. This suggests that these patients can be transplanted safely without concern for the development of EPS, at least within the follow-up period of 19 months.
包裹性腹膜硬化症（EPS）是腹膜透析（PD）最严重的并发症。2007年至2009年间发表的几篇回顾性报告表明，肾移植后EPS的发病率呈上升趋势。我们进行了一项前瞻性观察研究，以确定移植后EPS的发病率并识别可能的危险因素。
纳入2009年至2013年间连续接受肾移植的PD患者。包裹性腹膜硬化症定义为胃肠道梗阻并伴有EPS的影像学证据。使用自我管理的胃肠道症状评分量表（GSRS）问卷评估胃肠道症状。在移植后6个月和18个月前瞻性地进行腹部计算机断层扫描（CT）。主要终点是随访期间的EPS。
纳入53例PD患者（年龄51±14岁）。平均PD时间为31.3个月。86.8%的患者使用了葡萄糖降解产物含量低的腹膜透析液和艾考糊精。83.0%的患者记录为快速或平均快速转运状态。中位随访19个月后，47例患者的完整数据可用于分析。没有患者出现EPS的临床或影像学征象。GSRS评分从1.87提高到1.55（P = 0.024），体重从75.9 kg增加到78.3 kg（P = 0.003）。只有1例患者在移植后22个月的CT检查中出现新的局限性（<20%）腹膜增厚。
在这组腹膜透析暴露时间相对较短的患者中未发生移植后EPS。这表明这些患者可以安全地进行移植，而无需担心EPS的发生，至少在19个月的随访期内如此。
