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Warm ischemia time length during on-clamp partial nephrectomy: does it really matter?

Ali Abdel Raheem1,2, Ibrahim Alowidah3, Umberto Capitanio4

  • 1Department of Urology, Riyadh, Saudi Arabia - a-hassan@ksmc.med.sa.

Minerva Urology and Nephrology
|July 26, 2021
PubMed

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Summary

Warm ischemia time (WIT) exceeding 30 minutes does not impact long-term kidney function after partial nephrectomy. This study found no significant differences in renal recovery or chronic kidney disease progression between shorter and longer WIT groups.

Area of Science:

  • Nephrology
  • Urology
  • Surgical Oncology

Background:

  • The effect of warm ischemia time (WIT) on kidney function after partial nephrectomy (PN) is debated.
  • This study investigates the long-term renal functional outcomes associated with WIT exceeding 30 minutes during on-clamp PN.

Purpose of the Study:

  • To evaluate the impact of prolonged warm ischemia time (WIT > 30 min) on long-term renal function.
  • To compare renal functional recovery and chronic kidney disease (CKD) progression in patients undergoing on-clamp partial nephrectomy (PN) with varying WIT durations.

Main Methods:

  • A multicenter, retrospective analysis of 3526 patients undergoing on-clamp PN (2000-2018).
  • Patients with two kidneys, single cT1 tumor, and preoperative eGFR ≥60 mL/min/1.73m² were stratified by WIT ≤30 min or >30 min.

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  • Propensity-score matched analysis (1:1) compared eGFR, eGFR preservation, CKD upgrading, and CKD-free progression rates.

    • Main Results:

    • After propensity-score matching, no significant differences in median eGFR values at 1, 3, 5, and 10 years were observed between WIT groups.
    • eGFR preservation, absolute eGFR change, and 5-year CKD-free progression rates were comparable between groups.
    • WIT > 30 min was not a predictor of overall CKD upgrading or progression to stage ≥III CKD.

    Conclusions:

    • Warm ischemia time duration during on-clamp partial nephrectomy does not affect long-term renal function outcomes.
    • This finding applies to patients with two kidneys and adequate preoperative renal function (eGFR ≥60 mL/min/1.73m²).