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Abstract: TH-PO395

Four Year Outcomes, Efficacy, and Safety of Foam Sclerotherapy for Cysts in ADPKD and Autosomal-Dominant Polycystic Liver Disease (ADPLD)

Session Information

Category: Genetic Diseases of the Kidneys

  • 1101 Genetic Diseases of the Kidneys: Cystic

Authors

  • Bugazia, Seif, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Gregory, Adriana, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Torres, Vicente E., Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Rangel, Laureano J., Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Bendel, Emily, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Neidert, Newton, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Hogan, Marie C., Mayo Clinic Minnesota, Rochester, Minnesota, United States
Background

In 2017 we migrated from alcohol to sotradecol foam scleotherapy (SFS) in our practice, because of perceived improved efficacy. We studied changes in liver/kidney vols (TKV/TLV), renal fxn (ADPKD SFS cases) & QOL (LASA, PLD-Q).

Methods

Four-year data was analyzed from 1/1/2017-12/31/2021 in those who completed at least one SFS procedure. Segmentation was used to determine TKV/TLV before & after SFS (coronal MRI/axial CT) using artificial intelligence software. Impact on GFR decline, changes in TKV/TLV & adverse events (AEs) following SFS were assessed. Paired t-test was used for TKV/TLV (absolute & % annual change wrt baseline, IQR [Q1, Q3], changes in PLD-Q scores pre/post, multivariable logistic regression examined GFR trajectories pre/post SFS.

Results

We performed 160 SFS sessions (n=127 pts; 79 kidney; 41 with paired data; 81 liver, 6 liver/ kidney combined procedures (35 with paired data) in ADPKD (n= 86), ADPLD (n= 10), Cysts NOS (n= 19) cases. For cases with multi-procedures with available paired data: kidney (2 SFS, n=10, 3 SFS n= 2); for liver, six had 2, one had 5 sessions.

SFS was associated with a 26% [IQR -44, -6] reduction in TKV (p <.0001) with respect to baseline (n = 41; median, -191ml [IQR, -682, -83mL]; P < 0.0001). SFS was associated with a median difference of 277ml/yr TKV reduction (mean % +/- from baseline) in the treated kidneys (n = 41; [IQR, 77,- 683] mL) when compared with the contralateral untreated kidney for the same patient; P < 0.001).

SFS was associated with 8% [IQR -15, 1%] reduction of TLV (p=.0007) wrt baseline (n = 35; median,-243ml [IQR, -573, 47]; P < 0.03). There was no change in GFR slope in the SFS treated cases; (p=0.87;signed rank test). Most patients with flank/back/abdominal pain & distension had improvement in their symptoms; PLDQ (n=14) improved (p= .004) as did LASA QOL scores (p=.002 (n=22)). AEs: Five contrast leaks (retroperit/intracalyceal), 5 (4%) pain requiring 2 ER visits,1 cholangitis; (hospitalized);1 abortive SFS where the proceduralist unable to penetrate cyst.

Conclusion

SFS led to substantial changes in TKV and TLV and corresponding improvement in QOL related reductions in mass effects. There was no detectable benefit on eGFR decline in those who had SFS of kidney cysts in the ADPKD cases.

Funding

  • Private Foundation Support