ORIGINAL ARTICLE   Free access

Minerva Urology and Nephrology 2022 April;74(2):194-202

DOI: 10.23736/S2724-6051.21.04466-9

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

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

Ali ABDEL RAHEEM ^{1, 2} ✉, Ibrahim ALOWIDAH ¹, Umberto CAPITANIO ³, Francesco MONTORSI ³, Alessandro LARCHER ³, Ithaar DERWEESH ⁴, Fady GHALI ⁴, Alexander MOTTRIE ^{5, 6}, Elio MAZZONE ^{5, 6}, Geert DE NAEYER ⁵, Riccardo CAMPI ^{7, 8}, Francesco SESSA ^{7, 8}, Marco CARINI ^{8, 9}, Andrea MINERVINI ^{8, 9}, Jay D. RAMAN ⁹, Chris J. RJEPAJ ⁹, Maximilian C. KRIEGMAIR ¹⁰, Riccardo AUTORINO ¹¹, Alessandro VECCIA ¹¹, Maria C. MIR ¹², Francesco CLAPS ¹², Young D. CHOI ¹³, Won S. HAM ¹³, John P. TADIFA ¹⁴, Glen D. SANTOK ¹⁴, Maria FURLAN ¹⁵, Claudio SIMEONE ¹⁵, Maida BADA ¹⁶, Antonio CELIA ¹⁶, Diego M. CARRIÓN ¹⁷, Alfredo AGUILERA BAZAN ¹⁷, Cristina BALLESTEROS RUIZ ¹⁷, Manar MALKI ¹⁸, Neil BARBER ¹⁸, Muddassar HUSSAIN ¹⁸, Salvatore MICALI ¹⁹, Stefano PULIATTI ¹⁹, Abdelaziz ALWAHABI ¹, Abdulrahman ALQAHTANI ¹, Abdullah RUMAIH ¹, Ahmed GHAITH ², Ayman M. GHONEEM ², Ayman HAGRAS ², Ahmed EISSA ², Mohamed Jayed ALENZI ²⁰, Nicola PAVAN ²¹, Fabio TRAUNERO ²¹, Alessandro ANTONELLI ²², Antonio B. PORCARO ²², Ester ILLIANO ²³, Elisabetta COSTANTINI ²³, Koon H. RHA ¹³

¹ Department of Urology, Riyadh, Saudi Arabia; ² Department of Urology, Faculty of Medicine, Tanta University, Tanta, Egypt; ³ Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy; ⁴ UC San Diego School of Medicine, Department of Urology, La Jolla, CA, USA; ⁵ Department of Urology, Aalst, Belgium; ⁶ Department of Urology, Orsi Academy, Melle, Belgium; ⁷ Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy; ⁸ Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; ⁹ Department of Urological, Oncologic, Minimally-Invasive Robotic Surgery and Andrology, Careggi Hospital, University of Florence, Florence, Italy; ¹⁰ Department of Urology, Penn State Health Milton S. Hershey Medical Center Hershey, PA, USA; ¹¹ Department of Urology, University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany; ¹² Division of Urology, VCU Health, Richmond, VA, USA; ¹³ Department of Urology, Instituto Valenciano de Oncología (IVO), Valencia, Spain; ¹⁴ Department of Urology, Yonsei University College of Medicine, Urological Science Institute, Yonsei University Health System, Seoul, South Korea; ¹⁵ Department of Urology, National Kidney and Transplant Institute, Metro Manila, Philippines; ¹⁶ Department of Urology, ASST Spedali Civili, Brescia, Italy; ¹⁷ Department of Urology, Hospital S. Bassiano, Bassano del Grappa, Vicenza, Italy; ¹⁸ Department of Urology, La Paz University Hospital, Madrid, Spain; ¹⁹ Frimley Renal Cancer Center, Frimley Park Hospital Surrey, Frimley, UK; ²⁰ Department of Urology, University of Modena and Reggio Emilia, Modena, Italy; ²¹ Unit of Department of Urology, Al-Jouf University, Al-Jouf, Saudi Arabia; ²² Department of Urology, Trieste, Italy; ²⁴ Department of Urology, University Hospital of Verona, University of Verona, Verona, Italy; ²⁴ Andrological and Urogynecological Clinic, Santa Maria Terni Hospital, University of Perugia, Perugia, Italy

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/1.73m². 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 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/1.73m².

KEY WORDS: Nephrectomy; Warm ischemia; Delayed graft function