Ali Abdel Raheem, Ibrahim Alowidah, Umberto Capitanio, Francesco Montorsi, Alessandro Larcher, Ithaar Derweesh, Fady Ghali, Alexader Mottrie, Elio Mazzone, Geert DE Naeyer, Riccardo Campi, Francesco Sessa, Marco Carini, Andrea Minervini, Jay D Raman, Chris J Rjepaj, Maximilian C Kriegmair, Riccardo Autorino, Alessandro Veccia, Maria Carmen Mir, Francesco Claps, Young Deuk Choi, Won S Ham, John P Tadifa, Glen D Santok, Maria Furlan, Claudio Simeone, Maida Bada, Antonio Celia, Diego M Carrion, Alfredo Aguilera Bazan, Cristina B Ruiz, Manar Malki, Neil Barber, Muddassar Hussain, Salvatore Micali, Stefano Puliatti, Abdelaziz Alwahabi, Abdulrahman Alqahtani, Abdullah Rumaih, Ahmed Ghaith, Ayman M Ghoneem, Ayman Hagras, Ahmed Eissa, Mohammed J Alenzi, Nicola Pavan, Fabio Traunero, Alessandro Antonelli, Antonio B Porcaro, Ester Illiano, Elisabetta Costantini, Koon H Rha
- PMID: 34308610
- DOI: 10.23736/S2724-6051.21.04466-9
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 followup, 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 followup, 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.
