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

Autor:	Abdel Raheem A; Department of Urology, Riyadh, Saudi Arabia - a-hassan@ksmc.med.sa.; Department of Urology, Faculty of Medicine, Tanta University, Tanta, Egypt - a-hassan@ksmc.med.sa., Alowidah I; Department of Urology, Riyadh, Saudi Arabia., Capitanio U; Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy., Montorsi F; Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy., Larcher A; Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy., Derweesh I; UC San Diego School of Medicine, Department of Urology, La Jolla, CA, USA., Ghali F; UC San Diego School of Medicine, Department of Urology, La Jolla, CA, USA., Mottrie A; Department of Urology, Aalst, Belgium.; Department of Urology, Orsi Academy, Melle, Belgium., Mazzone E; Department of Urology, Aalst, Belgium.; Department of Urology, Orsi Academy, Melle, Belgium., DE Naeyer G; Department of Urology, Aalst, Belgium., Campi R; Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy.; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy., Sessa F; Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy.; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy., Carini M; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.; Department of Urological, Oncologic, Minimally-Invasive Robotic Surgery and Andrology, Careggi Hospital, University of Florence, Florence, Italy., Minervini A; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.; Department of Urological, Oncologic, Minimally-Invasive Robotic Surgery and Andrology, Careggi Hospital, University of Florence, Florence, Italy., Raman JD; Department of Urological, Oncologic, Minimally-Invasive Robotic Surgery and Andrology, Careggi Hospital, University of Florence, Florence, Italy., Rjepaj CJ; Department of Urological, Oncologic, Minimally-Invasive Robotic Surgery and Andrology, Careggi Hospital, University of Florence, Florence, Italy., Kriegmair MC; Department of Urology, Penn State Health Milton S. Hershey Medical Center Hershey, PA, USA., Autorino R; Department of Urology, University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany., Veccia A; Department of Urology, University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany., Mir MC; Division of Urology, VCU Health, Richmond, VA, USA., Claps F; Division of Urology, VCU Health, Richmond, VA, USA., Choi YD; Department of Urology, Instituto Valenciano de Oncología (IVO), Valencia, Spain., Ham WS; Department of Urology, Instituto Valenciano de Oncología (IVO), Valencia, Spain., Tadifa JP; Department of Urology, Yonsei University College of Medicine, Urological Science Institute, Yonsei University Health System, Seoul, South Korea., Santok GD; Department of Urology, Yonsei University College of Medicine, Urological Science Institute, Yonsei University Health System, Seoul, South Korea., Furlan M; Department of Urology, National Kidney and Transplant Institute, Metro Manila, Philippines., Simeone C; Department of Urology, National Kidney and Transplant Institute, Metro Manila, Philippines., Bada M; Department of Urology, ASST Spedali Civili, Brescia, Italy., Celia A; Department of Urology, ASST Spedali Civili, Brescia, Italy., Carrión DM; Department of Urology, Hospital S. Bassiano, Bassano del Grappa, Vicenza, Italy., Aguilera Bazan A; Department of Urology, Hospital S. Bassiano, Bassano del Grappa, Vicenza, Italy., Ballesteros Ruiz C; Department of Urology, Hospital S. Bassiano, Bassano del Grappa, Vicenza, Italy., Malki M; Department of Urology, La Paz University Hospital, Madrid, Spain., Barber N; Department of Urology, La Paz University Hospital, Madrid, Spain., Hussain M; Department of Urology, La Paz University Hospital, Madrid, Spain., Micali S; Frimley Renal Cancer Center, Frimley Park Hospital Surrey, Frimley, UK., Puliatti S; Frimley Renal Cancer Center, Frimley Park Hospital Surrey, Frimley, UK., Alwahabi A; Department of Urology, Riyadh, Saudi Arabia., Alqahtani A; Department of Urology, Riyadh, Saudi Arabia., Rumaih A; Department of Urology, Riyadh, Saudi Arabia., Ghaith A; Department of Urology, Faculty of Medicine, Tanta University, Tanta, Egypt., Ghoneem AM; Department of Urology, Faculty of Medicine, Tanta University, Tanta, Egypt., Hagras A; Department of Urology, Faculty of Medicine, Tanta University, Tanta, Egypt., Eissa A; Department of Urology, Faculty of Medicine, Tanta University, Tanta, Egypt., Alenzi MJ; Department of Urology, University of Modena and Reggio Emilia, Modena, Italy., Pavan N; Unit of Department of Urology, Al-Jouf University, Al-Jouf, Saudi Arabia., Traunero F; Unit of Department of Urology, Al-Jouf University, Al-Jouf, Saudi Arabia., Antonelli A; Department of Urology, Trieste, Italy., Porcaro AB; Department of Urology, Trieste, Italy., Illiano E; Department of Urology, University Hospital of Verona, University of Verona, Verona, Italy., Costantini E; Department of Urology, University Hospital of Verona, University of Verona, Verona, Italy., Rha KH; Department of Urology, Instituto Valenciano de Oncología (IVO), Valencia, Spain.
Jazyk:	angličtina
Zdroj:	Minerva urology and nephrology [Minerva Urol Nephrol] 2022 Apr; Vol. 74 (2), pp. 194-202. Date of Electronic Publication: 2021 Jul 26.
DOI:	10.23736/S2724-6051.21.04466-9
Abstrakt:	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/1.73m 2 . 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/1.73m 2 .
Databáze:	MEDLINE
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