MILAN—An intravascular treatment for intractable symptomatic polycystic kidney and liver due to autosomal dominant polycystic kidney disease (ADPKD) is highly effective, according to the findings of a Japanese study.
Tatsuya Suwabe, MD, of the Nephrology Center at Toranomon Hospital Kajigaya, Kanagawa, Japan, reported the results from a series of 579 patients with enlarged polycystic kidney and 243 patients with enlarged polycystic liver treated with transcatheter arterial embolization (TAE). Of the 579 patients with enlarged kidneys, 106 also had enlarged livers.
“Since kidney and liver in ADPKD patients are usually supplied by well-developed arteries, we attempted to contract the enlarged organs by TAE, using intravascular platinum microcoils as the embolization material,” Dr. Suwabe said.
Except for patients who died of other causes, all patients undergoing renal TAE had a favorable clinical course. Seventeen patients underwent renal transplantation; 15 had nephrectomy and two did not.
Of the 243 hepatic TAE patients, 202 had a favorable clinical course, but improvement was not observed in 41 patients with severe liver damage marked by massive ascites and cystic infection, he reported.
“TAE is generally more effective for enlarged kidney than liver.…[the] average volume reduction [in the kidney] exceeds 50%, compared with about 20% for the liver,” he said.
In one of the more dramatic examples, a patient with liver-dominant cysts achieved a reduction in total hepatic volume from 9,659 cm3 to 3,225 cm3 and reduction in intrahepatic cyst volume from 8,427 cm3 to 1,736 cm3. Reductions were maintained for one year after TAE. Hepatic parenchyma, however, increased, Dr. Suwabe reported.
“Before hepatic TAE, there is a gradual growth of cysts. After TAE, cysts become less tense and begin to shrink, and the decompressed parenchyma tends to expand in volume and return to its original position,” he explained.
The TAE procedure was well-tolerated both kidney-dominant or liver-dominant patients, though one patient with renal metastasis of bladder cancer died after renal TAE, he noted.