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Abdel Raheem A, Alowidah I, Capitanio U, Montorsi F, Larcher A, Derweesh I, Ghali F, Mottrie A, Mazzone E, DE Naeyer G, Campi R, Sessa F, Carini M, Minervini A, Raman JD, Rjepaj CJ, Kriegmair MC, Autorino R, Veccia A, Mir MC, Claps F, Choi YD, Ham WS, Tadifa JP, Santok GD, Furlan M, Simeone C, Bada M, Celia A, Carrion DM, Aguilera Bazan A, Ruiz CB, Malki M, Barber N, Hussain M, Micali S, Puliatti S, Alwahabi A, Alqahtani A, Rumaih A, Ghaith A, Ghoneem AM, Hagras A, Eissa A, Alenzi MJ, Pavan N, Traunero F, Antonelli A, Porcaro AB, Illiano E, Costantini E, Rha KH. Warm ischemia time length during on-clamp partial nephrectomy: dose it really matter? Minerva Urol Nephrol 2021; 74:194-202. [PMID: 34308610 DOI: 10.23736/s2724-6051.21.04466-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
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.
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Affiliation(s)
- Ali Abdel Raheem
- Department of Urology, Hersn, Riyadh, Saudi Arabia - .,Department of Urology, Faculty of Medicine, Tanta University, Tanta, Egypt -
| | | | - Umberto Capitanio
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alessandro Larcher
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Ithaar Derweesh
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA, USA
| | - Fady Ghali
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA, USA
| | - Alexader Mottrie
- Department of Urology, O.L.V. Hospital, Aalst, Belgium.,Department of Urology, Orsi Academy, Melle, Belgium
| | - Elio Mazzone
- Department of Urology, O.L.V. Hospital, Aalst, Belgium.,Department of Urology, Orsi Academy, Melle, Belgium
| | | | - Riccardo Campi
- Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Francesco Sessa
- Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Marco Carini
- Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Andrea Minervini
- Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Jay D Raman
- Division of Urology, Penn State Health Milton S. Hershey Medical Center Hershey, PA, USA
| | - Chris J Rjepaj
- Division of Urology, Penn State Health Milton S. Hershey Medical Center Hershey, PA, USA
| | - Maximilian C Kriegmair
- Department of Urology, University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | | | | | - Maria Carmen Mir
- Department of Urology, Fundación Instituto Valenciano Oncología, Valencia, Spain
| | - Francesco Claps
- Department of Urology, Fundación Instituto Valenciano Oncología, Valencia, Spain
| | - Young Deuk Choi
- Department of Urology, Severance Hospital, Seoul, South Korea
| | - Won S Ham
- Department of Urology, Severance Hospital, Seoul, South Korea
| | - John P Tadifa
- Department of Urology, National Kidney and Transplant Institute, Metro Manila, Philippines
| | - Glen D Santok
- Department of Urology, National Kidney and Transplant Institute, Metro Manila, Philippines
| | - Maria Furlan
- Department of Urology, ASST-Spedali Civili, Brescia, Italy
| | | | - Maida Bada
- Department of Urology, Hospital S. Bassiano, Bassano del Grappa, Vicenza, Italy
| | - Antonio Celia
- Department of Urology, Hospital S. Bassiano, Bassano del Grappa, Vicenza, Italy
| | - Diego M Carrion
- Department of Urology, La Paz University Hospital, Madrid, Spain
| | | | - Cristina B Ruiz
- Department of Urology, La Paz University Hospital, Madrid, Spain
| | - Manar Malki
- Frimley Renal Cancer Centre Frimley Park Hospital Surrey, Camberley UK
| | - Neil Barber
- Frimley Renal Cancer Centre Frimley Park Hospital Surrey, Camberley UK
| | - Muddassar Hussain
- Frimley Renal Cancer Centre Frimley Park Hospital Surrey, Camberley UK
| | - Salvatore Micali
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefano Puliatti
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | | | - Ahmed Ghaith
- Department of Urology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Ayman M Ghoneem
- Department of Urology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Ayman Hagras
- Department of Urology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Ahmed Eissa
- Department of Urology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Mohammed J Alenzi
- Department of Urology unit, Al-Jouf University, Al-Jouf, Saudi Arabia
| | | | | | | | - Antonio B Porcaro
- Department of Urology, AOUI Verona, University of Verona, Verona, Italy
| | - Ester Illiano
- Andrological and Urogynecological Clinic, Santa Maria Terni Hospital, University of Perugia, Perugia, Italy
| | - Elisabetta Costantini
- Andrological and Urogynecological Clinic, Santa Maria Terni Hospital, University of Perugia, Perugia, Italy
| | - Koon H Rha
- Department of Urology, Severance Hospital, Seoul, South Korea
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