Korean J Transplant.  2023 Nov;37(Suppl 1):S119. 10.4285/ATW2023.F-7017.

Effectiveness of renal transcatheter arterial embolization for kidney transplant waitlist Waitlist patients with autosomal dominant polycystic kidney: reduced cyst size and decreased pretransplant nephrectomy

• Kim S

• KMID: 2551739
• DOI: http://doi.org/10.4285/ATW2023.F-7017

Abstract

Autosomal dominant polycystic kidney (ADPKD) can cause pressure-related symptoms such as abdominal discomfort, pain, and dyspepsia due to the increased kidney size, often necessitating additional nephrectomy during transplantation. This article aims to report the effectiveness of renal transcatheter arterial embolization (TAE) in reducing cyst size and decreasing the need for pretransplant nephrectomy in ADPKD patients. A 44-year-old man with end-stage renal disease secondary to ADPKD visited the outpatient clinic for a pretransplant nephrectomy due to severe abdominal distension. He had been on maintenance hemodialysis for 1 month and faced challenges eating a normal portion of food. Both kidneys were palpable in the whole abdomen. Computed tomography revealed a significantly enlarged kidney with numerous cysts, compressing other abdominal organs. Due to his low hemoglobin level (6.9 mg/dL), raising concerns for blood transfusion during nephrectomy, renal TAE was performed to reduce kidney size. Six detachable coils (ConcertoTM, Medtronic Inc.) were used to embolize the right renal artery. The patient experienced severe abdominal pain in the first 3 days following the procedure, gradually subsiding over the next few days. Approximately 18 months later, there was a 56% decrease in the cross-section area of the right kidney. The patient reported an increase in appetite and a reduction in abdominal distension. Renal TAE appears to be an effective and safe therapeutic option that improves the quality of life by alleviating symptoms in ADPKD patients. Moreover, it offers the advantage of making transplantation possible without the need for nephrectomy, which is associated with higher complications. However, addressing and managing severe abdominal pain after the embolization procedure is essential. Additionally, the treatment may require considerable time to achieve the desired effect. Despite these considerations, renal TAE is recommended for patients on the kidney transplant waiting list as it brings numerous advantages.