Transplant Trial Watch

Volume Reduction in Enlarged Kidneys in Autosomal Dominant Polycystic Kidney Disease (ADPKD) Prior to Renal Transplant with Transcatheter Arterial Embolization (TAE): A Systematic Review and Meta-Analysis.

Ye W, Voss MD, et al.

Cardiovascular & Interventional Radiology 2018; 41(6): 828-834.

To conduct a systematic review and meta-analysis to determine the efficiency of transcatheter arterial embolization (TAE) to reduce renal volume prior to kidney transplantation and compression symptoms associated with autosomal dominant polycystic kidney disease (ADPKD).

The databases PubMed, Web of Science, and the Cochrane Library were searched until October 10, 2017 for studies where participants received TAE for enlarged kidney and examined various clinical outcomes as a measurement for TAE success with a minimum of 3-month follow-up post-TAE. The references list of relevant articles were also reviewed for potential studies that may have been missed by initial searches. Data was extracted independently from included studies using a standardized form.

Six studies were included in the analysis, four of which were retrospective studies, and two were prospective studies.

The primary outcome measured was success of TAE which was indicated by compression symptoms, transplant contraindication, and lung function. Complications of TAE, TAE failure and embolization agent were also measured.

3 - 24 months

CET Conclusions
This systematic review focused on Transcatheter Arterial Embolisation (TAE) for the management of large polycystic kidneys in APKD. Only 6 studies met the inclusion criteria and this paper gives no quality assessment of these studies. Embolization agents included Polyviny alcohol (PVA), microcoils and ethanol. Average volume reduction of approximately 50% was seen at 3 month follow up. Success of TAE was reported as removal of the contraindication for transplantation (90% success), reduction in compressive symptoms (98%) and improved pulmonary function (71%) although only 1-3 studies reported on each of these outcomes. Post-embolization syndrome (fever, nausea, pain in first 72 hours) was found in 20% if prophlyaxis was given. The authors acknowledge that it is challenging to develop evidence-based recommendations based on the available data.

Quality notes
Quality assessment not appropriate

Trial registration

Funding source
Not reported