Impact of ischaemia time on renal function after partial nephrectomy: a systematic review

Area of Science:

• Nephrology
• Urology
• Surgical Research

Background:

• Partial nephrectomy (PN) is a standard treatment for kidney tumors.
• Assessing the impact of warm ischemia time on renal function is crucial for surgical outcomes.

Purpose of the Study:

• To evaluate the effect of warm ischemia on kidney function following partial nephrectomy.
• To determine the safety threshold for warm ischemia time during PN.

Main Methods:

• A systematic literature review was conducted adhering to PRISMA guidelines.
• Searches of Medline and Embase databases were performed for studies on warm ischemia and partial nephrectomy.
• Included studies focused on solitary kidney models or assessed split renal function in two-kidney models.

Main Results:

• Nine studies with solitary kidneys found no negative impact of warm ischemia time on postoperative renal function below a 25-minute threshold.
• The quality and quantity of preserved kidney parenchyma were identified as key factors influencing renal function post-PN.
• Prolonged warm ischemia (>25-30 minutes) was suggested to cause irreversible ischemic injury.

Conclusions:

• Limited warm ischemia time (≤25 minutes) poses no greater risk to renal function compared to zero ischemia techniques during PN.
• Prolonged warm ischemia during PN may lead to irreversible damage to the surgically treated kidney.