#WCE2014 - How a donor nephrectomy population can help clarify warm renal ischemia effects during partial nephrectomy - Interview

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).

wceMethods: 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 

 

Conference Coverage
 
Recent data from conferences worldwide
  • 2020 Virtual Congress / September 19-21
  • 2020 BCAN Think Tank Virtual / August 7
  • 2020 Virtual Education Program / August 8-10
  • 2020 Annual Meeting / July 17-19 / EAU Virtual Program
  • SUO - AUA 2020 Summer Webcast / July 18
  • 2020 Annual Meeting / June 27-28 / AUA Live Virtual Program
  • 2020 Annual Meeting / May 29-31 / Virtual Scientific Program
  • 2020 Annual Meeting / February 13-15 / San Francisco, CA
  • 2019 Annual Meeting / December 4-6 / Washington, DC
  • 2019 Annual Meeting / October 3 - October 5 / Aarhus, Denmark
  • 2019 Annual Congress / September 27 - October 1 / Barcelona, Spain
  • 2019 Biennial Meeting / August 29-31 / Basel, Switzerland