Mp63-02 how a donor nephrectomy population can help clarify the effects of warm renal ischemia during partial nephrectomy

You have accessJournal of UrologyKidney Cancer: Surgical Therapy IV1 Apr 2015MP63-02 HOW A DONOR NEPHRECTOMY POPULATION CAN HELP CLARIFY THE EFFECTS OF WARM RENAL ISCHEMIA DURING PARTIAL NEPHRECTOMY Roger Li, Herbert C. Ruckle, Muhannad Alsyouf, Michelle Lightfoot, Jared Schober, David Tryon, Kristene Myklak, David Culpepper, Daniel Faaborg, Phillip Stokes, Javier L. Arenas, and D. Duane Baldwin Roger LiRoger Li More articles by this author , Herbert C. RuckleHerbert C. Ruckle More articles by this author , Muhannad AlsyoufMuhannad Alsyouf More articles by this author , Michelle LightfootMichelle Lightfoot More articles by this author , Jared SchoberJared Schober More articles by this author , David TryonDavid Tryon More articles by this author , Kristene MyklakKristene Myklak More articles by this author , David CulpepperDavid Culpepper More articles by this author , Daniel FaaborgDaniel Faaborg More articles by this author , Phillip StokesPhillip Stokes More articles by this author , Javier L. ArenasJavier L. Arenas More articles by this author , and D. Duane BaldwinD. Duane Baldwin More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2334AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The most important modifiable risk factors for kidney function after partial nephrectomy (PN) are the quantity of parenchyma removed and the length of warm ischemia time (WIT) although the relative importance of these two factors has been debated. In this study, the effects of WIT on renal function were investigated by comparing PN patients to completely healthy patients undergoing donor nephrectomy (DN). METHODS A retrospective review was performed of 119 PN and 250 DN patients at a single academic institution. Baseline characteristics, WIT, and follow-up serum creatinine (sCr) at discharge, 1-7months and at last follow-up were compared. Estimated GFR (eGFR) was calculated using sCr and the Modification of Diet on Renal Disease (MDRD) formula. Data was analyzed using the Mann-Whitney U and Chi-square tests as appropriate. RESULTS The DN patients were younger (37.5 vs. 60.8; p<0.01), had lower BMI (26.6 vs. 30.9; p<0.01), lower ASA scores (p<0.01) and higher preoperative eGFR (101.7 vs. 78.4; p<0.01). In the PN cohort, the median tumor size was 3.6 cm and mean WIT was 27.8 minutes. DN patients were found to have greater eGFR decline upon discharge (-42.7% vs. -1.5%, p<0.01), at 1-7 mos postoperatively (-36.9% vs. -6.4%; p<0.01) and at the latest follow-up (-36.3% vs. -2.4%; p<0.01). The percentage decrease in eGFR was also significantly greater in donor nephrectomy patients than partial nephrectomy patients with WIT > 30 minutes at all time points including discharge (-42.7% vs. -4.1%; p<0.01) at 1-7 mos (-36.9% vs. -3.8%; p<0.01) and at latest follow-up (-36.3% vs. -6.9%; p<0.01). CONCLUSIONS Despite being younger and healthier, the donors had a much greater decrease in GFR than all PN patients including those with > 30 min WIT. This dramatic benefit of partial nephrectomy compared with radical nephrectomy in all patients emphasizes the benefit to GFR derived from renal parenchymal preservation. Surgeons should utilize warm renal ischemia when indicated if it facilitates the preservation of renal parenchyma. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e789 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Roger Li More articles by this author Herbert C. Ruckle More articles by this author Muhannad Alsyouf More articles by this author Michelle Lightfoot More articles by this author Jared Schober More articles by this author David Tryon More articles by this author Kristene Myklak More articles by this author David Culpepper More articles by this author Daniel Faaborg More articles by this author Phillip Stokes More articles by this author Javier L. Arenas More articles by this author D. Duane Baldwin More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...