Ali Abdel Raheem1,2, Ibrahim Alowidah3, Umberto Capitanio4, Francesco Montorsi4, Alessandro Larcher4, Ithaar Derweesh5, Fady Ghali5, Alexander Mottrie6,7, Elio Mazzone6,7, Geert DE Naeyer6, Riccardo Campi8,9, Francesco Sessa8,9, Marco Carini9,10, Andrea Minervini9,10, Jay D Raman10, Chris J Rjepaj10, Maximilian C Kriegmair11, Riccardo Autorino12, Alessandro Veccia12, Maria C Mir13, Francesco Claps13, Young D Choi14, Won S Ham14, John P Tadifa15, Glen D Santok15, Maria Furlan16, Claudio Simeone16, Maida Bada17, Antonio Celia17, Diego M Carrión18, Alfredo Aguilera Bazan18, Cristina Ballesteros Ruiz18, Manar Malki19, Neil Barber19, Muddassar Hussain19, Salvatore Micali20, Stefano Puliatti20, Abdelaziz Alwahabi3, Abdulrahman Alqahtani3, Abdullah Rumaih3, Ahmed Ghaith21, Ayman M Ghoneem21, Ayman Hagras21, Ahmed Eissa21, Mohamed Jayed Alenzi22, Nicola Pavan23, Fabio Traunero23, Alessandro Antonelli24, Antonio B Porcaro24, Ester Illiano25, Elisabetta Costantini25, Koon H Rha14. 1. Department of Urology, Riyadh, Saudi Arabia - a-hassan@ksmc.med.sa. 2. Department of Urology, Faculty of Medicine, Tanta University, Tanta, Egypt - a-hassan@ksmc.med.sa. 3. Department of Urology, Riyadh, Saudi Arabia. 4. Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy. 5. UC San Diego School of Medicine, Department of Urology, La Jolla, CA, USA. 6. Department of Urology, Aalst, Belgium. 7. Department of Urology, Orsi Academy, Melle, Belgium. 8. Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy. 9. Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy. 10. Department of Urological, Oncologic, Minimally-Invasive Robotic Surgery and Andrology, Careggi Hospital, University of Florence, Florence, Italy. 11. Department of Urology, Penn State Health Milton S. Hershey Medical Center Hershey, PA, USA. 12. Department of Urology, University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany. 13. Division of Urology, VCU Health, Richmond, VA, USA. 14. Department of Urology, Instituto Valenciano de Oncología (IVO), Valencia, Spain. 15. Department of Urology, Yonsei University College of Medicine, Urological Science Institute, Yonsei University Health System, Seoul, South Korea. 16. Department of Urology, National Kidney and Transplant Institute, Metro Manila, Philippines. 17. Department of Urology, ASST Spedali Civili, Brescia, Italy. 18. Department of Urology, Hospital S. Bassiano, Bassano del Grappa, Vicenza, Italy. 19. Department of Urology, La Paz University Hospital, Madrid, Spain. 20. Frimley Renal Cancer Center, Frimley Park Hospital Surrey, Frimley, UK. 21. Department of Urology, Faculty of Medicine, Tanta University, Tanta, Egypt. 22. Department of Urology, University of Modena and Reggio Emilia, Modena, Italy. 23. Unit of Department of Urology, Al-Jouf University, Al-Jouf, Saudi Arabia. 24. Department of Urology, Trieste, Italy. 25. Department of Urology, University Hospital of Verona, University of Verona, Verona, Italy.
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 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.
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.
Authors: Stefano Puliatti; Ahmed Eissa; Enrico Checcucci; Pietro Piazza; Marco Amato; Stefania Ferretti; Simone Scarcella; Juan Gomez Rivas; Mark Taratkin; Josè Marenco; Ines Belenchon Rivero; Karl-Friedrich Kowalewski; Giovanni Cacciamani; Ahmed El-Sherbiny; Ahmed Zoeir; Abdelhamid M El-Bahnasy; Ruben De Groote; Alexandre Mottrie; Salvatore Micali Journal: Asian J Urol Date: 2022-06-01
Authors: Andrea Piasentin; Francesco Claps; Tommaso Silvestri; Giacomo Rebez; Fabio Traunero; Maria Carmen Mir; Michele Rizzo; Antonio Celia; Calogero Cicero; Martina Urbani; Luca Balestreri; Lisa Pola; Fulvio Laganà; Stefano Cernic; Maria Assunta Cova; Michele Bertolotto; Carlo Trombetta; Giovanni Liguori; Nicola Pavan Journal: Medicina (Kaunas) Date: 2022-08-03 Impact factor: 2.948