Impact of warm versus cold ischemia on renal function following partial nephrectomy

Scott E. Eggener, Melanie A. Clark, Sergey Shikanov, Benjamin Smith, Matthew G. Kaag, Paul Russo, Jeffrey C. Wheat, J. Stuart Wolf, Surena F. Matin, William C. Huang, Miriam Harel, Joseph Cambio, Arieh L. Shalhav, Jay Raman

Research output: Contribution to journalArticle

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Abstract

Introduction: We evaluated renal function following partial nephrectomy with cold ischemia (CI) versus warm ischemia (WI).

Methods: Data were collected from 1,396 patients at six institutions who underwent partial nephrectomy for a renal mass with normal contralateral kidney to evaluate percent change in glomerular filtration rate (GFR) at 3–18 months. A multivariate linear regression model tested the association of percent change GFR with clinical, operative, and pathologic factors.

Results: A total of 874 patients (63 %) underwent PN with CI and 522 (37 %) with WI. All patients undergoing laparoscopic and robotic-assisted partial nephrectomy (n = 443) had WI, whereas 92 % of open partial nephrectomy patients (n = 953) had CI. The CI group had a lower mean baseline GFR (72 vs. 80 ml/min/1.73 m2), longer median ischemia time (33 vs. 29 min), and larger mean tumor size (3.2 vs. 2.9 cm) with more advanced pathologic stage (T1b-T3: 25 vs. 16 %) (all p values <0.001). Patients with CI and WI demonstrated 12.3 and 10.1 % reductions in renal function from baseline, respectively (p = 0.067). Increasing age, female gender, and increasing tumor size were associated with reduction in renal function (all p values <0.001). Neither renal hypothermia nor operative technique independently predicted reduced renal function. Sensitivity analyses limited to ischemia time >30 min, baseline estimated glomerular filtration rate <60 ml/min/1.73 m2, or tumors >4 cm did not significantly alter the findings.

Conclusions: Increasing age, female gender, and larger tumor size independently predict a decrease in renal function following partial nephrectomy with a normal contralateral kidney. Within the limitations of a non-randomized comparison, including lack of parenchymal preservation percentage, neither surgical approach (open or laparoscopic) nor presence of hypothermia appears to be associated with long-term renal function.

Original languageEnglish (US)
Pages (from-to)351-357
Number of pages7
JournalWorld Journal of Urology
Volume33
Issue number3
DOIs
StatePublished - Jan 1 2015

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Cold Ischemia
Nephrectomy
Glomerular Filtration Rate
Kidney
Warm Ischemia
Linear Models
Robotics
Hypothermia
Neoplasms
Ischemia

All Science Journal Classification (ASJC) codes

  • Urology

Cite this

Eggener, Scott E. ; Clark, Melanie A. ; Shikanov, Sergey ; Smith, Benjamin ; Kaag, Matthew G. ; Russo, Paul ; Wheat, Jeffrey C. ; Wolf, J. Stuart ; Matin, Surena F. ; Huang, William C. ; Harel, Miriam ; Cambio, Joseph ; Shalhav, Arieh L. ; Raman, Jay. / Impact of warm versus cold ischemia on renal function following partial nephrectomy. In: World Journal of Urology. 2015 ; Vol. 33, No. 3. pp. 351-357.
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title = "Impact of warm versus cold ischemia on renal function following partial nephrectomy",
abstract = "Introduction: We evaluated renal function following partial nephrectomy with cold ischemia (CI) versus warm ischemia (WI).Methods: Data were collected from 1,396 patients at six institutions who underwent partial nephrectomy for a renal mass with normal contralateral kidney to evaluate percent change in glomerular filtration rate (GFR) at 3–18 months. A multivariate linear regression model tested the association of percent change GFR with clinical, operative, and pathologic factors.Results: A total of 874 patients (63 {\%}) underwent PN with CI and 522 (37 {\%}) with WI. All patients undergoing laparoscopic and robotic-assisted partial nephrectomy (n = 443) had WI, whereas 92 {\%} of open partial nephrectomy patients (n = 953) had CI. The CI group had a lower mean baseline GFR (72 vs. 80 ml/min/1.73 m2), longer median ischemia time (33 vs. 29 min), and larger mean tumor size (3.2 vs. 2.9 cm) with more advanced pathologic stage (T1b-T3: 25 vs. 16 {\%}) (all p values <0.001). Patients with CI and WI demonstrated 12.3 and 10.1 {\%} reductions in renal function from baseline, respectively (p = 0.067). Increasing age, female gender, and increasing tumor size were associated with reduction in renal function (all p values <0.001). Neither renal hypothermia nor operative technique independently predicted reduced renal function. Sensitivity analyses limited to ischemia time >30 min, baseline estimated glomerular filtration rate <60 ml/min/1.73 m2, or tumors >4 cm did not significantly alter the findings.Conclusions: Increasing age, female gender, and larger tumor size independently predict a decrease in renal function following partial nephrectomy with a normal contralateral kidney. Within the limitations of a non-randomized comparison, including lack of parenchymal preservation percentage, neither surgical approach (open or laparoscopic) nor presence of hypothermia appears to be associated with long-term renal function.",
author = "Eggener, {Scott E.} and Clark, {Melanie A.} and Sergey Shikanov and Benjamin Smith and Kaag, {Matthew G.} and Paul Russo and Wheat, {Jeffrey C.} and Wolf, {J. Stuart} and Matin, {Surena F.} and Huang, {William C.} and Miriam Harel and Joseph Cambio and Shalhav, {Arieh L.} and Jay Raman",
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Eggener, SE, Clark, MA, Shikanov, S, Smith, B, Kaag, MG, Russo, P, Wheat, JC, Wolf, JS, Matin, SF, Huang, WC, Harel, M, Cambio, J, Shalhav, AL & Raman, J 2015, 'Impact of warm versus cold ischemia on renal function following partial nephrectomy', World Journal of Urology, vol. 33, no. 3, pp. 351-357. https://doi.org/10.1007/s00345-014-1315-4

Impact of warm versus cold ischemia on renal function following partial nephrectomy. / Eggener, Scott E.; Clark, Melanie A.; Shikanov, Sergey; Smith, Benjamin; Kaag, Matthew G.; Russo, Paul; Wheat, Jeffrey C.; Wolf, J. Stuart; Matin, Surena F.; Huang, William C.; Harel, Miriam; Cambio, Joseph; Shalhav, Arieh L.; Raman, Jay.

In: World Journal of Urology, Vol. 33, No. 3, 01.01.2015, p. 351-357.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Impact of warm versus cold ischemia on renal function following partial nephrectomy

AU - Eggener, Scott E.

AU - Clark, Melanie A.

AU - Shikanov, Sergey

AU - Smith, Benjamin

AU - Kaag, Matthew G.

AU - Russo, Paul

AU - Wheat, Jeffrey C.

AU - Wolf, J. Stuart

AU - Matin, Surena F.

AU - Huang, William C.

AU - Harel, Miriam

AU - Cambio, Joseph

AU - Shalhav, Arieh L.

AU - Raman, Jay

PY - 2015/1/1

Y1 - 2015/1/1

N2 - Introduction: We evaluated renal function following partial nephrectomy with cold ischemia (CI) versus warm ischemia (WI).Methods: Data were collected from 1,396 patients at six institutions who underwent partial nephrectomy for a renal mass with normal contralateral kidney to evaluate percent change in glomerular filtration rate (GFR) at 3–18 months. A multivariate linear regression model tested the association of percent change GFR with clinical, operative, and pathologic factors.Results: A total of 874 patients (63 %) underwent PN with CI and 522 (37 %) with WI. All patients undergoing laparoscopic and robotic-assisted partial nephrectomy (n = 443) had WI, whereas 92 % of open partial nephrectomy patients (n = 953) had CI. The CI group had a lower mean baseline GFR (72 vs. 80 ml/min/1.73 m2), longer median ischemia time (33 vs. 29 min), and larger mean tumor size (3.2 vs. 2.9 cm) with more advanced pathologic stage (T1b-T3: 25 vs. 16 %) (all p values <0.001). Patients with CI and WI demonstrated 12.3 and 10.1 % reductions in renal function from baseline, respectively (p = 0.067). Increasing age, female gender, and increasing tumor size were associated with reduction in renal function (all p values <0.001). Neither renal hypothermia nor operative technique independently predicted reduced renal function. Sensitivity analyses limited to ischemia time >30 min, baseline estimated glomerular filtration rate <60 ml/min/1.73 m2, or tumors >4 cm did not significantly alter the findings.Conclusions: Increasing age, female gender, and larger tumor size independently predict a decrease in renal function following partial nephrectomy with a normal contralateral kidney. Within the limitations of a non-randomized comparison, including lack of parenchymal preservation percentage, neither surgical approach (open or laparoscopic) nor presence of hypothermia appears to be associated with long-term renal function.

AB - Introduction: We evaluated renal function following partial nephrectomy with cold ischemia (CI) versus warm ischemia (WI).Methods: Data were collected from 1,396 patients at six institutions who underwent partial nephrectomy for a renal mass with normal contralateral kidney to evaluate percent change in glomerular filtration rate (GFR) at 3–18 months. A multivariate linear regression model tested the association of percent change GFR with clinical, operative, and pathologic factors.Results: A total of 874 patients (63 %) underwent PN with CI and 522 (37 %) with WI. All patients undergoing laparoscopic and robotic-assisted partial nephrectomy (n = 443) had WI, whereas 92 % of open partial nephrectomy patients (n = 953) had CI. The CI group had a lower mean baseline GFR (72 vs. 80 ml/min/1.73 m2), longer median ischemia time (33 vs. 29 min), and larger mean tumor size (3.2 vs. 2.9 cm) with more advanced pathologic stage (T1b-T3: 25 vs. 16 %) (all p values <0.001). Patients with CI and WI demonstrated 12.3 and 10.1 % reductions in renal function from baseline, respectively (p = 0.067). Increasing age, female gender, and increasing tumor size were associated with reduction in renal function (all p values <0.001). Neither renal hypothermia nor operative technique independently predicted reduced renal function. Sensitivity analyses limited to ischemia time >30 min, baseline estimated glomerular filtration rate <60 ml/min/1.73 m2, or tumors >4 cm did not significantly alter the findings.Conclusions: Increasing age, female gender, and larger tumor size independently predict a decrease in renal function following partial nephrectomy with a normal contralateral kidney. Within the limitations of a non-randomized comparison, including lack of parenchymal preservation percentage, neither surgical approach (open or laparoscopic) nor presence of hypothermia appears to be associated with long-term renal function.

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JO - World Journal of Urology

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