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Minerva Urology and Nephrology 2021 Jul 26

DOI: 10.23736/S2724-6051.21.04466-9

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Warm ischemia time length during on-clamp partial nephrectomy: dose 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, Alexader MOTTRIE 5, 6, Elio MAZZONE 5, 6, Geert DE NAEYER 5, Riccardo CAMPI 7, 8, Francesco SESSA 7, 8, Marco CARINI 7, 8, Andrea MINERVINI 7, 8, Jay D. RAMAN 9, Chris J. RJEPAJ 9, Maximilian C. KRIEGMAIR 10, Riccardo AUTORINO 11, Alessandro VECCIA 11, Maria Carmen MIR 12, Francesco CLAPS 12, Young Deuk 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. CARRION 17, Alfredo AGUILERA BAZAN 17, Cristina B. 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, Mohammed J. 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, Hersn, 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 Ospedale San Raffaele, Milan, Italy; 4 Department of Urology, UC San Diego School of Medicine, La Jolla, CA, USA; 5 Department of Urology, O.L.V. Hospital, Aalst, Belgium; 6 Department of Urology, Orsi Academy, Melle, Belgium; 7 Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, Florence, Italy; 8 Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; 9 Division of Urology, Penn State Health Milton S. Hershey Medical Center Hershey, PA, USA; 10 Department of Urology, University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany; 11 Division of Urology, VCU Health, Richmond, VA, USA; 12 Department of Urology, Fundación Instituto Valenciano Oncología, Valencia, Spain; 13 Department of Urology, Severance Hospital, Seoul, South Korea; 14 Department of Urology, National Kidney and Transplant Institute, Metro Manila, Philippines; 15 Department of Urology, ASST-Spedali Civili, Brescia, Italy; 16 Department of Urology, Hospital S. Bassiano, Bassano del Grappa, Vicenza, Italy; 17 Department of Urology, La Paz University Hospital, Madrid, Spain; 18 Frimley Renal Cancer Centre Frimley Park Hospital Surrey, Camberley UK; 19 Department of Urology, University of Modena and Reggio Emilia, Modena, Italy; 20 Department of Urology unit, Al-Jouf University, Al-Jouf, Saudi Arabia; 21 Department of Urology, Trieste, Italy; 22 Department of Urology, AOUI Verona, University of Verona, Verona, Italy; 23 Andrological and Urogynecological Clinic, Santa Maria Terni Hospital, University of Perugia, Perugia, Italy


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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 followup, 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 followup, 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: Partial nephrectomy; Warm ischemia time; Renal function

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