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Minerva Urology and Nephrology 2022 April;74(2):194-202

DOI: 10.23736/S2724-6051.21.04466-9


language: English

Warm ischemia time length during on-clamp partial nephrectomy: does it really matter?

Ali ABDEL RAHEEM 1, 2 , Ibrahim ALOWIDAH 1, Umberto CAPITANIO 3, Francesco MONTORSI 3, Alessandro LARCHER 3, Ithaar DERWEESH 4, Fady GHALI 4, Alexander MOTTRIE 5, 6, Elio MAZZONE 5, 6, Geert DE NAEYER 5, Riccardo CAMPI 7, 8, Francesco SESSA 7, 8, Marco CARINI 8, 9, Andrea MINERVINI 8, 9, Jay D. RAMAN 9, Chris J. RJEPAJ 9, Maximilian C. KRIEGMAIR 10, Riccardo AUTORINO 11, Alessandro VECCIA 11, Maria C. MIR 12, Francesco CLAPS 12, Young D. CHOI 13, Won S. HAM 13, John P. TADIFA 14, Glen D. SANTOK 14, Maria FURLAN 15, Claudio SIMEONE 15, Maida BADA 16, Antonio CELIA 16, Diego M. CARRIÓN 17, Alfredo AGUILERA BAZAN 17, Cristina BALLESTEROS RUIZ 17, Manar MALKI 18, Neil BARBER 18, Muddassar HUSSAIN 18, Salvatore MICALI 19, Stefano PULIATTI 19, Abdelaziz ALWAHABI 1, Abdulrahman ALQAHTANI 1, Abdullah RUMAIH 1, Ahmed GHAITH 2, Ayman M. GHONEEM 2, Ayman HAGRAS 2, Ahmed EISSA 2, Mohamed Jayed ALENZI 20, Nicola PAVAN 21, Fabio TRAUNERO 21, Alessandro ANTONELLI 22, Antonio B. PORCARO 22, Ester ILLIANO 23, Elisabetta COSTANTINI 23, Koon H. RHA 13

1 Department of Urology, Riyadh, Saudi Arabia; 2 Department of Urology, Faculty of Medicine, Tanta University, Tanta, Egypt; 3 Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy; 4 UC San Diego School of Medicine, Department of Urology, La Jolla, CA, USA; 5 Department of Urology, Aalst, Belgium; 6 Department of Urology, Orsi Academy, Melle, Belgium; 7 Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy; 8 Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; 9 Department of Urological, Oncologic, Minimally-Invasive Robotic Surgery and Andrology, Careggi Hospital, University of Florence, Florence, Italy; 10 Department of Urology, Penn State Health Milton S. Hershey Medical Center Hershey, PA, USA; 11 Department of Urology, University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany; 12 Division of Urology, VCU Health, Richmond, VA, USA; 13 Department of Urology, Instituto Valenciano de Oncología (IVO), Valencia, Spain; 14 Department of Urology, Yonsei University College of Medicine, Urological Science Institute, Yonsei University Health System, Seoul, South Korea; 15 Department of Urology, National Kidney and Transplant Institute, Metro Manila, Philippines; 16 Department of Urology, ASST Spedali Civili, Brescia, Italy; 17 Department of Urology, Hospital S. Bassiano, Bassano del Grappa, Vicenza, Italy; 18 Department of Urology, La Paz University Hospital, Madrid, Spain; 19 Frimley Renal Cancer Center, Frimley Park Hospital Surrey, Frimley, UK; 20 Department of Urology, University of Modena and Reggio Emilia, Modena, Italy; 21 Unit of Department of Urology, Al-Jouf University, Al-Jouf, Saudi Arabia; 22 Department of Urology, Trieste, Italy; 24 Department of Urology, University Hospital of Verona, University of Verona, Verona, Italy; 24 Andrological and Urogynecological Clinic, Santa Maria Terni Hospital, University of Perugia, Perugia, Italy

BACKGROUND: The impact of warm ischemia time (WIT) on renal functional recovery remains controversial. We examined the length of WIT>30 min on the long-term renal function following on-clamp partial nephrectomy (PN).
METHODS: Data from 23 centers for patients undergoing on-clamp PN between 2000 and 2018 were analyzed. We included patients with two kidneys, single tumor, cT1, minimum 1-year follow-up, and preoperative eGFR≥60 mL/min/1.73m2. Patients were divided into two groups according to WIT length: group I “WIT≤30 min” and group II “WIT>30 min.” A propensity-score matched analysis (1:1 match) was performed to eliminate potential confounding factors between groups. We compared eGFR values, eGFR (%) preservation, eGFR decline, events of chronic kidney disease (CKD) upgrading, and CKD-free progression rates between both groups. Cox regression analysis evaluated WIT impact on upgrading of CKD stages.
RESULTS: The primary cohort consisted of 3526 patients: group I (N.=2868) and group II (N.=658). After matching the final cohort consisted of 344 patients in each group. At last follow-up, there were no significant differences in median eGFR values at 1, 3, 5, and 10 years (P>0.05) between the matched groups. In addition, the median eGFR (%) preservation and absolute eGFR change were similar (89% in group I vs. 87% in group II, P=0.638) and (-10 in group I vs. -11 in group II, P=0.577), respectively. The 5 years new-onset CKD-free progression rates were comparable in the non-matched groups (79% in group I vs. 81% in group II, log-rank, P=0.763) and the matched groups (78.8% in group I vs. 76.3% in group II, log-rank, P=0.905). Univariable Cox regression analysis showed that WIT>30 min was not a predictor of overall CKD upgrading (HR:0.953, 95%CI 0.829-1.094, P=0.764) nor upgrading into CKD stage ≥III (HR:0.972, 95%CI 0.805-1.173, P=0.764). Retrospective design is a limitation of our study.
CONCLUSIONS: Our analysis based on a large multicenter international cohort study suggests that WIT length during PN has no effect on the long-term renal function outcomes in patients having two kidneys and preoperative eGFR≥60 mL/min/1.73m2.

KEY WORDS: Nephrectomy; Warm ischemia; Delayed graft function

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