Introduction Kidney cyst infections are serious complications in autosomal dominant polycystic kidney disease (ADPKD). Kidney transcatheter arterial embolization (TAE) reduces kidney volume in this population. We tested the hypothesis that TAE could prevent kidney cyst infections. Methods This retrospective cohort study included 416 ADPKD patients who underwent kidney TAE, including 70 with a prior kidney cyst infection. The primary outcome was the annual frequency of kidney cyst infections. Secondary outcomes included hospitalization duration. Risk factors for post-TAE infection recurrence were identified by multivariable linear regression. Results In the primary cohort, the frequency of cyst infections decreased from 0.291 episodes/year pre-TAE to 0.087 post-TAE (p<0.001). In the subgroup with a prior infection, the frequency decreased from 1.73 ± 1.18 to 0.49 ± 0.96 episodes/year (p<0.001), and hospitalization days decreased from 34.1 ± 26.1 to 9.90 ± 24.4 days/year (p<0.001). The reduction effect was pronounced in patients with a greater total kidney volume reduction rate (TKV-RR); no infections were observed in patients who achieved a TKV-RR >75%. Multivariable analysis revealed pre-TAE infection frequency (β=0.23; p=0.017), a lower TKV-RR (β=-0.01; p=0.034), and antibiotic use at TAE (β=0.68; p=0.007) as independent risk factors for post-TAE infection recurrence. Even among patients who consistently used antibiotics, the infection frequency decreased post-TAE. Conclusions Kidney TAE is a promising technique for reducing kidney cyst infections in ADPKD patients. TAE should be performed after full remission without antibiotic therapy, but TAE reduces cyst infection even in consistent antibiotic users. Early, extensive embolization might be particularly beneficial in high-risk patients.
