TAIPEI, TAIWAN (UroToday.com) - Introduction and Objectives: The most important modifiable risk factors for kidney function after partial nephrectomy (PN) are the quantity of parenchyma removed and the length of warm ischemia time (WIT). In this study, we further investigate the effects of WIT on renal function by comparing PN patients to completely healthy patients undergoing total donor nephrectomy (DN).
Methods: We performed a retrospective review of 92 PN and 242 DN patients at a single academic institution. Baseline characteristics, WIT, and follow-up serum Creatinine (sCr) at discharge, 1–7 months and at last follow-up were compared. Estimated GFR (eGFR) was calculated using sCr and the Modification of Diet on Renal Disease (MDRD) formula. Data was analyzed using the Mann-Whitney U and Chi-square tests as appropriate.
Results: The DN patients were younger (37.4 vs. 60.2; p < 0.001), and had lower EBL(103.0 vs. 287.9; p < 0.001), BMI(26.5 vs. 30.8; p < 0.001), and ASA(1 vs. 2.7; p < 0.001). They were also less likely to require transfusions intraoperatively (p = 0.001) and had higher preoperative eGFR(101.6 vs. 78.1; p < 0.001). In the PN cohort, the median tumor size was 3.2 cm and mean WIT was 27.9 minutes. DN patients were found to have greater eGFR decline upon discharge ( - 46.7% vs. - 4.2%, p < 0.001), at 1–7 month postoperatively ( - 36.9% vs. - 5.5%; p < 0.001) and at the latest follow-up ( - 38.0% vs. - 2.4%; p < 0.001).
Conclusions: In the PN cohort, warm ischemia in patients with greater medical comorbidity resulted in much less decrease in GFR than a total nephrectomy performed in a completely healthy donor population. The primary concern for surgeons performing partial nephrectomy should be renal preservation not warm ischemia time.
Source of Funding: None
|Listen to an interview with Javier Arenas, one of the authors of this study.|
Presented by Daniel Faaborg, Roger Li, Herbert C. Ruckle, Jared Schober, Michelle Lightfoot, Muhannad Alsyouf, Phillip Stokes, David Culpepper, David Tryon, Gene O. Huang, Javier Arenas, and D. Duane Baldwin at the 32nd World Congress of Endourology & SWL- September 3 - 7, 2014 - Taipei, Taiwan
Loma Linda University Medical Center, Loma Linda, CA USA