• Junichi Hoshino, Yoshifumi Ubara, Tatsuya Suwabe, Keiichi Sumida, Noriko Hayami, Koki Mise, Rikako Hiramatsu, Eiko Hasegawa, Masayuki Yamanouchi, Naoki Sawa, Ryoji Takei, and Kenmei Takaichi.
• Nephrology Center, Toranomon Hospital, Tokyo, Japan. Electronic address: hoshino@toranomon.gr.jp.
• Am. J. Kidney Dis. 2014 Jun 1; 63 (6): 937-44.

BackgroundHepatic transcatheter arterial embolization (TAE) has become an accepted treatment option for patients with symptomatic autosomal dominant polycystic kidney disease (ADPKD) who also have polycystic liver disease and who are not good candidates for surgery. However, indications for TAE and long-term outcome with it are still unclear.Study DesignRetrospective cohort study.Setting & ParticipantsSymptomatic patients with ADPKD with polycystic liver disease who underwent hepatic TAE, June 2001 to December 2012, at Toranomon Hospital and whose liver volume data were available were studied (N=244; 56% on dialysis therapy, none with kidney transplants). Mean age was 55 ± 9 (SD) years, and mean liver volumes were 8,353 ± 2,807 and 6,626 ± 2,485 cm(3) in men and women, respectively. Target arteries were embolized from the periphery using platinum microcoils.PredictorsSex-specific quartiles (6,433, 8,142, and 9,574 cm(3) in men and 4,638, 6,078, and 8,181 cm(3) in women) of total liver volume pretreatment.OutcomesAll causes of mortality were obtained from medical records, followed up until July 31, 2013.MeasurementsLaboratory values were measured before TAE and 1, 3, 6, and 12 months after. Organ volumes were measured pretreatment, then 6 and 12 months after, by summing the products of the organ areas traced in each computed tomographic image.ResultsLiver/cyst volume decreased to 94.7% (95% CI, 93.5%-95.8%) at 6 months and 90.8% (95% CI, 88.7%-92.9%) at 12 months of pretreatment volumes. Serum protein and hematocrit values improved significantly without liver damage. Survival was significantly better for patients with liver volume ≤ 9,574 cm(3) (men) and ≤ 8,181 cm(3) (women) than for those with larger livers (5-year survival, 69% and 48%; P=0.02). Infection and liver failure caused most deaths, especially in patients with larger livers.LimitationsReferral bias and lack of control group.ConclusionsHepatic TAE appears to be a safe and less invasive option for patients with symptomatic polycystic liver, especially those contraindicated for surgical treatment (eg, with malnutrition or on dialysis therapy), improving both hepatic volume and nutrition.Copyright © 2014 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

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