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

2021; Volume: 74; Issue: 2 Linguagem: Inglês

10.23736/s2724-6051.21.04466-9

2724-6442

Ali Abdel Raheem, Ibrahim Alowidah, Umberto Capitanio, Francesco Montorsi, Alessandro Larcher, Ithaar Derweesh, Fady Ghali, Alexandre Mottrie, Elio Mazzone, Geert De Naeyer, Riccardo Campi, Francesco Sessa, Marco Carini, Andrea Minervini, Jay D. Raman, Chris Rjepaj, Maximilian C. Kriegmair, Riccardo Autorino, Alessandro Veccia, Maria Carmen Mir, Francesco Claps, Young Deuk Choi, Won Sik Ham, John Paul Tadifa, Glen Denmer Santok, Maria Furlan, Claudio Simeone, Maida Bada, Antonio Celia, Diego M. Carrión, Alfredo Aguilera Bazán, Cristina Ballesteros Ruiz, Manar Malki, Neil Barber, Muddassar Hussain, Salvatore Micali, Stefano Puliatti, Abdelaziz Alwahabi, Abdulrahman Alqahtani, Abdullah Rumaih, Ahmed Ghaith, Ayman Ghoneem, Ayman Hagras, Ahmed Eissa, Mohamed Jayed Alenzi, Nicola Pavan, Fabio Traunero, Alessandro Antonelli, Antonio Benito Porcaro, Ester Illiano, Elisabetta Costantini, Koon Ho Rha,

MRI in cancer diagnosis

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).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.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.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.