Presented by: Kai Wen Cheng MD
Loma Linda

Introduction

Patients with chronic liver disease are high-risk surgical candidates given their coagulopathic state and risk of metabolic complications. Cryoablation may be a less invasive option for these high-risk patients with small renal tumors. While renal cryoablation has been shown to be successful in the general population, little information exists regarding outcomes in patients with chronic liver disease. The study's purpose was to evaluate the outcomes of renal cryoablation in patients with chronic liver disease.

Materials

A retrospective review was performed on patients who underwent renal cryoablation at a single academic institution from April 2013 to October 2022. Patients were compared based on the presence or absence of chronic liver disease/cirrhosis. The primary endpoints were recurrence-free and overall survival. Secondary endpoints included complication rates, hospital stay, blood transfusions, and ICU admission. Chi Square test and Wilcoxon rank sum test were used to compare outcomes between patients with and without chronic liver disease. The Kaplan-Meier log rank test was used for recurrence-free and overall survival, with p≤0.05 considered significant.  

Results

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A total of 131 cryoablations were analyzed, and out of these 14 (10.7%) had chronic liver disease/cirrhosis, with a mean MELD score of 9.6. Patients were followed for a mean of 19.3±28.6 months. Liver disease patients were younger (64 vs 70 years, p=0.019), but there were no significant differences in preoperative tumor characteristics, including nephrometry score (5.9 vs 6.4; p=0.16), mean tumor grade (1.7 vs 1.7; p=0.88), and mean tumor size (2.9 vs 3.1 cm; p=0.28) in the no liver disease and chronic liver disease groups, respectively. Overall survival in patients with chronic liver disease was lower (p=0.050; Figure 1a), but there was no difference in recurrence-free survival between groups (p=0.096; Figure 1b). There were no post-operative patient mortalities and transfusion rates were similar between groups (p>0.05).  

Conclusion

In patients with reasonable life expectancy or patients needing renal tumor treatment prior to liver transplantation, renal cryoablation is feasible and safe, with acceptable procedural and oncologic outcomes. 

Funding

None

Lead Authors

Matthew Buell, MD
Loma Linda University Health

Co-Authors

Matthew Wilson,
Loma Linda University Health

Daniel Jhang,
Loma Linda University Health

Jason Smith, MD
Loma Linda University Health

Vance Gentry,
Loma Linda University Health

Akin S. Amasyali, MD
Loma Linda University Health

Rose Leu, MD
Loma Linda University Health

Kanha Shete, DO
Loma Linda University Health

Ala'a Farkouh, MD
Loma Linda University Health

Katya Hanessian,
Loma Linda University Health

Kai Wen Cheng, MD
Loma Linda University Health

D. Duane Baldwin, MD
Loma Linda University Health