Ayar Y, Ersoy A, Ocakoglu G, Gullulu E, Kagızmanlı H, Yıldız A, Oruc A, Yavuz M, Gullulu M, Dilek K
Uludag University Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Bursa, Turkey.
Uludag University Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Bursa, Turkey.
Transplant Proc. 2018 Jan-Feb;50(1):160-164. doi: 10.1016/j.transproceed.2017.12.054.
Encapsulating peritoneal sclerosis (EPS) is a serious complication for patients with chronic kidney disease (CKD) who were treated with long-term peritoneal dialysis (PD). The risk of EPS was increased after kidney transplantation. In our study we evaluated risk factors for EPS patients after kidney transplantation who were treated before with PD.
In our study, between January 2008 and August 2015, 47 PD patients (12 had EPS) who underwent kidney transplantation were analyzed. Age, gender, time of PD treatment, human leukocyte antigen (HLA) matching, cold ischemia time, kidney function (serum urea, creatinine, etc), comorbidities, immunosuppressive therapy, clinical features, and outcomes of PD patients were retrospectively evaluated in both groups.
Mean age was 42 (range, 25-60) years in EPS patients, versus 43 (range, 22-77) years without EPS (P = .798). Distribution of gender was similar in both groups (P = .154). The C-reactive protein levels (P < .001), number of patients with peritonitis (P = .001), length of time on PD (P < .001), and serum ferritin levels (P = .020) were higher in EPS patients. The immunosuppressive therapy was changed; tamoxifen and steroids were used after diagnosis in EPS patients. HLA matching was higher in the non-EPS group (P = .006). EPS was more often seen in patients who were treated with continuous ambulatory peritoneal dialysis (CAPD; 75%; P = .036). EPS was more often detected in cadaveric transplant recipients (83.3%; P = .024). High peritoneal transmittance rate was more identified in EPS (+) patients (P = .001). EPS was more often seen in patients who were treated with icodextrin-based regimens in PD before transplantation (91.7%; P = .037). The length of time on PD and high ferritin levels increased EPS 1.08 and 1.01, respectively (P = .036 and .049, respectively), in multivariate analysis.
The length of time on PD, type of PD, PD regimens with icodextrin, episodes of peritonitis, and peritoneal transmittance in patients with CKD affect the development of EPS after transplantation.
包裹性腹膜硬化（EPS）是长期接受腹膜透析（PD）治疗的慢性肾脏病（CKD）患者的一种严重并发症。肾移植后EPS风险增加。在本研究中，我们评估了既往接受过PD治疗的肾移植后EPS患者的风险因素。
本研究分析了2008年1月至2015年8月期间47例接受肾移植的PD患者（其中12例发生EPS）。回顾性评估两组患者的年龄、性别、PD治疗时间、人类白细胞抗原（HLA）配型、冷缺血时间、肾功能（血清尿素、肌酐等）、合并症、免疫抑制治疗、临床特征及PD治疗结局。
EPS患者的平均年龄为42岁（范围25 - 60岁），未发生EPS患者的平均年龄为43岁（范围22 - 77岁）（P = 0.798）。两组性别分布相似（P = 0.154）。EPS患者的C反应蛋白水平（P < 0.001）、腹膜炎患者数量（P = 0.001）、PD治疗时间（P < 0.001）及血清铁蛋白水平（P = 0.020）更高。免疫抑制治疗方案有所改变；EPS患者诊断后使用了他莫昔芬和类固醇。非EPS组的HLA配型更佳（P = 0.006）。EPS在接受持续性非卧床腹膜透析（CAPD）治疗的患者中更常见（75%；P = 0.036）。在尸体肾移植受者中更常检测到EPS（83.3%；P = 0.024）。EPS阳性患者中更常发现高腹膜转运率（P = 0.001）。EPS在移植前接受基于艾考糊精方案的PD治疗患者中更常见（91.7%；P = 0.037）。多因素分析显示，PD治疗时间和高铁蛋白水平分别使EPS风险增加1.08倍和1.01倍（分别为P = 0.036和0.049）。
CKD患者的PD治疗时间、PD类型、含艾考糊精的PD方案、腹膜炎发作次数及腹膜转运情况会影响移植后EPS的发生。
