Warm ischemia time length during on-clamp partial nephrectomy: does it really matter?
Ali ABDEL RAHEEM, Ibrahim ALOWIDAH, Umberto CAPITANIO, Francesco MONTORSI, Alessandro LARCHER, Ithaar DERWEESH, Fady GHALI, Alexander 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 C. MIR, Francesco CLAPS, Young D. CHOI, Won S. HAM, John P. TADIFA, Glen D. SANTOK, Maria FURLAN, Claudio SIMEONE, Maida BADA, Antonio CELIA, Diego M. CARRIÓN, Alfredo AGUILERA BAZAN, Cristina BALLESTEROS 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, Mohamed Jayed ALENZI, Nicola PAVAN, Fabio TRAUNERO, Alessandro ANTONELLI, Antonio B. PORCARO, Ester ILLIANO, Elisabetta COSTANTINI, Koon H. RHA
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: . 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: .