Reducing polycystic liver volume in ADPKD: effects of somatostatin analogue octreotide

Abstract

Background and objectives: No medical treatment is available for polycystic liver disease, a frequent manifestation of autosomal-dominant polycystic kidney disease (ADPKD). In a prospective, randomized, double-blind, crossover study, 6 months of octreotide (40 mg every 28 days) therapy limited kidney volume growth more effectively than placebo in 12 patients with ADPKD.

Design, setting, participants, & measurements: In this secondary, post hoc analysis of the above study, octreotide-induced changes in liver volumes compared with placebo and the relationship between concomitant changes in liver and kidney volumes were evaluated. Those analyzing liver and kidney volumes were blinded to treatment.

Results: Liver volumes significantly decreased from 1595 +/- 478 ml to 1524 +/- 453 ml with octreotide whereas they did not appreciably change with placebo. Changes in liver volumes were significantly different between the two treatment periods (-71 +/- 57 ml versus +14 +/- 85 ml). Octreotide-induced liver volume reduction was fully explained by a reduction in parenchyma volume from 1506 +/- 431 ml to 1432 +/- 403 ml. Changes in liver volumes were significantly correlated with concomitant changes in kidney volumes (r = 0.67) during octreotide but not during placebo treatment. Liver and kidney volume changes significantly differed with both treatments (octreotide: -71 +/- 57 ml versus +71 +/- 107; placebo: +14 +/- 85 ml versus +162 +/- 114), but net reductions in liver (-85 +/- 103 ml) and kidney (-91 +/- 125 ml) volume growth on octreotide versus placebo were similar.

Conclusions: Octreotide therapy reduces liver volumes in patients with ADPKD and is safe.

Figure 1.

Volume quantification method using stereology. Original CT image of a baseline liver scan acquisition from patient 3 (left), and the same liver scan with a stereology grid showing points within the liver parenchyma (crosses) and within cysts (full circles).

Figure 2.

Absolute changes in total liver volume (delta TLV) during 6 months of octreotide or placebo therapy in 12 patients with ADPKD. Horizontal thick and thin segments denote mean and SEM, respectively. *P < 0.005 versus pretreatment TLV (Wilcoxon test for paired observations).

Figure 3.

Absolute changes in total liver volume (delta TLV) during 6 months of octreotide or placebo therapy in 12 patients with ADPKD. Horizontal thick and thin segments denote mean and SEM, respectively. *P < 0.05 octreotide versus placebo (Wilcoxon test for paired observations).

Figure 4.

Correlations between absolute changes in total liver volumes (delta TLV) and concomitant changes in total kidney volumes (delta TKV) during 6 months of (left) octreotide or (right) placebo therapy (Spearman correlation).

Figure 5.

Changes in total liver volume (delta TLV) and total kidney volume (delta TKV) during 6 months of (left) octreotide or (right) placebo therapy. *P < 0.0005 and P < 0.005 between delta TLV and delta TKV during octreotide and placebo treatment, respectively (Wilcoxon test for paired observations).