Clinical

Arterial embolization reduces liver cysts in polycystic kidney disease

Last Updated: 2007-07-10 17:12:02 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Transcutaneous arterial embolization of the hepatic artery reduces liver cyst volume in patients with autosomal dominant polycystic kidney disease and symptomatic polycystic liver, according to a report in the June American Journal of Kidney Diseases.

Renal arterial embolization has been shown to be effective in reducing renal cysts, the authors explain, but renal transcutaneous arterial embolization did not benefit patients with primarily hepatic enlargement.

Dr. Ryoji Takei and colleagues from Toranomon Hospital Kajigaya, Japan performed hepatic transcutaneous arterial embolization in 30 polycystic kidney disease patients with multiple liver cysts and evaluated their outcomes.

After treatment, total volume of intrahepatic cysts decreased from 6677 cc to 4625 cc, the authors report, and total liver volume decreased from 7882 cc to 6041 cc. As a result, hepatic parenchyma increased from 1205 cc to 1406 cc.

Most patients began to experience relief of symptoms within 1 to 2 months of arterial embolization, Dr. Takei and associates say, even before objective confirmation of hepatic size decrease.

Serum levels of liver enzymes and bilirubin increased after the transcutaneous procedure but returned to baseline levels within 12 months, the study results indicate.

Complications of the procedure included transient pain in the hypochondrium and a transient increase in body temperature, both of which subsided within 5 days.

"Our treatment to date may be less effective in decreasing total liver volume than surgical resection," Dr. Takei's team concludes. "However, our treatment should be safe even when performed repeatedly or after a relapse after surgical therapy."

"Hepatic transcutaneous arterial embolization may also be an option for treatment of patients with symptomatic polycystic liver in poor general medical condition who are not candidates for hepatic resection," the researchers add.

"More experience with selective hepatic artery embolization by other groups is needed to confirm the safety and efficacy of this procedure," writes Dr. Vicente E. Torres from the Mayo Clinic College of Medicine, Rochester, Minnesota in a related editorial. "Currently, it may be best suited to treat highly symptomatic patients who have large areas of cystic liver without recognizable hepatic parenchyma and are not good candidates for combined liver resection and cyst fenestration."

"Octreotide, a synthetic, metabolically stable somatostatin analog, has been shown to inhibit cAMP accumulation in the bile ducts and to halt the expansion of hepatic cysts from polycystic kidney rats in vitro and in vivo," Dr. Torres adds. "A clinical trial of long-acting release octreotide for patients who are not candidates for or who decline surgery for severe polycystic liver disease is currently in progress."

Am J Kidney Dis 2007;49:744-752,725-728.