Kidney Transcatheter Arterial Embolization Reduces Kidney Cyst Infection in Patients With ADPKD

Kidney cyst infections are serious complications in autosomal dominant polycystic kidney disease (ADPKD). Kidney transcatheter arterial embolization (TAE) reduces kidney volume in this population. We tested the hypothesis that TAE could prevent kidney cyst infections.

This retrospective cohort study included 416 patients with ADPKD who underwent kidney TAE (primary cohort), including 70 patients with a previous kidney cyst infection. The primary outcome was the annual frequency of kidney cyst infections. Secondary outcomes included hospitalization duration. The risk factors for post-TAE infection recurrence were identified by multivariable linear regression.

In the primary cohort, the frequency of cyst infections decreased from 0.291 episodes per year pre-TAE to 0.087 post-TAE (P < 0.001). In the subgroup with a previous infection, the frequency decreased from 1.73 ± 1.18 to 0.49 ± 0.96 episodes per year (P < 0.001), and hospitalization days decreased from 34.1 ± 26.1 to 9.90 ± 24.4 days per year (P < 0.001). The reduction effect was pronounced in patients with a greater total kidney volume reduction rate (TKV-RR). No infections were observed in patients who achieved a TKV-RR > 75%. Multivariable analysis revealed pre-TAE infection frequency (β = 0.23; P = 0.017), a lower TKV-RR (β = -0.01; P = 0.034), and antibiotic use at TAE (β = 0.68; P = 0.007) as independent risk factors for post-TAE infection recurrence. Even among patients who consistently used antibiotics, the infection frequency decreased post-TAE.

Kidney TAE is a promising technique for reducing kidney cyst infections in patients with ADPKD. TAE should be performed after full remission without antibiotic therapy, but TAE reduces cyst infection even in consistent antibiotic users. Early, extensive embolization might be particularly beneficial in patients at high-risk.