mTOR inhibitors for management of encapsulating peritoneal sclerosis: a review of literatures

Abstract

Background: Encapsulating peritoneal sclerosis (EPS) is an infrequent, serious complication of peritoneal dialysis (PD). EPS may develop after kidney transplantation of PD-treated patients possibly due to the fibrotic effect of calcineurin inhibitors (CNIs). Some experimental and clinical studies proposed inhibitors of mammalian target of rapamycin (mTOR) for EPS management due to their anti-fibrotic and anti-angiogenesis effects. This review evaluated the therapeutic role of mTOR inhibitors in the management of EPS.

Method: Thirteen case reports/series consisted of 20 patients (16 post-transplant and four post-hemodialysis EPS cases) were evaluated. We tried to extract the effect of mTOR inhibitors according to authors’ conclusion and the time of improvement of patients’ symptoms and each treatment modality such as surgery, parenteral nutrition, tamoxifen and mTOR inhibitors.

Results: Of 20 patients, clinical improvement of five patients (25%) is more attributable to mTOR inhibitor therapy. All these five patients were post-kidney transplant EPS cases. Therefore, EPS improvement rate in post-transplant EPS patients was 31.25% (5 of 16 patients). Death after EPS diagnosis occurred in two of seven patients with continued CNIs therapy (28.57%) and 1 of 11 cases (9.09%) who didn’t receive CNIs after EPS diagnosis.

Conclusion: Although the therapeutic effect of mTOR inhibitors against EPS remains unproven, it seems that for patients with post kidney transplant EPS who do not have any contraindication for mTOR inhibitor administration, converting from CNIs to mTOR inhibitors in addition to other EPS treatments may result in improving EPS in approximately one-third of patients and decreasing patients’ mortality.

Keywords:

• Encapsulating peritoneal sclerosis
• everolimus
• kidney transplantation
• mTOR inhibitors
• sirolimus

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.