Comparison of warm ischemia versus no ischemia during partial nephrectomy on a solitary kidney

R. Houston Thompson, Brian R. Lane, Christine M. Lohse, Bradley C. Leibovich, Amr Fergany, Igor Frank, Inderbir S. Gill, Steven C. Campbell, Michael L. Blute

Research output: Contribution to journalArticle

113 Citations (Scopus)

Abstract

Background: The safe duration of warm ischemia during partial nephrectomy (PN) remains controversial. Objective: To compare the short- and long-term renal effects of warm ischemia versus no ischemia in patients with a solitary kidney. Design, setting, and participants: Using the Cleveland Clinic and Mayo Clinic databases, we identified 458 patients who underwent open (n = 411) or laparoscopic (n = 47) PN for a renal mass in a solitary kidney between 1990 and 2008. Patients treated with cold ischemia were excluded. Measurements: Associations of ischemia type (none vs warm) with short- and long-term renal function were evaluated using logistic or Cox regression models. Results and limitations: No ischemia was used in 96 patients (21%), while 362 patients (79%) had a median of 21 min (range: 4-55) of warm ischemia. Patients treated with warm ischemia had a significantly higher preoperative glomerular filtration rate (GFR; median: 61 ml/min per 1.73 m2 vs 54 ml/min per 1.73 m 2; p < 0.001) and larger tumors (median: 3.4 cm vs 2.5 cm; p < 0.001) compared with patients treated with no ischemia. Warm ischemia patients were significantly more likely to develop acute renal failure (odds ratio [OR]: 2.1; p = 0.044) and a GFR <15 ml/min per 1.73 m2 in the postoperative period (OR: 4.2; p = 0.007) compared with patients who did not have hilar clamping. Among the 297 patients with a preoperative GFR ≥30 ml/min per 1.73 m2, patients with warm ischemia were significantly more likely to develop new-onset stage IV chronic kidney disease (hazard ratio: 2.3; p = 0.028) during a mean follow-up of 3.3 yr. Similar results were obtained adjusting for preoperative GFR, tumor size, and type of PN in a multivariable analysis. Limitations include surgeon selection bias when determining type of ischemia. Conclusions: Warm ischemia during PN is associated with adverse renal consequences. Although selection bias is present, PN without ischemia should be used when technically feasible in patients with a solitary kidney.

Original languageEnglish (US)
Pages (from-to)331-336
Number of pages6
JournalEuropean Urology
Volume58
Issue number3
DOIs
StatePublished - Sep 2010

Fingerprint

Warm Ischemia
Nephrectomy
Ischemia
Kidney
Selection Bias
Odds Ratio
Cold Ischemia
Glomerular Filtration Rate
Chronic Renal Insufficiency
Proportional Hazards Models
Acute Kidney Injury
Postoperative Period
Constriction
Neoplasms

Keywords

  • Ischemia
  • Kidney neoplasms
  • Nephrectomy
  • Postoperative complications
  • Warm ischemia

ASJC Scopus subject areas

  • Urology

Cite this

Thompson, R. H., Lane, B. R., Lohse, C. M., Leibovich, B. C., Fergany, A., Frank, I., ... Blute, M. L. (2010). Comparison of warm ischemia versus no ischemia during partial nephrectomy on a solitary kidney. European Urology, 58(3), 331-336. https://doi.org/10.1016/j.eururo.2010.05.048

Comparison of warm ischemia versus no ischemia during partial nephrectomy on a solitary kidney. / Thompson, R. Houston; Lane, Brian R.; Lohse, Christine M.; Leibovich, Bradley C.; Fergany, Amr; Frank, Igor; Gill, Inderbir S.; Campbell, Steven C.; Blute, Michael L.

In: European Urology, Vol. 58, No. 3, 09.2010, p. 331-336.

Research output: Contribution to journalArticle

Thompson, RH, Lane, BR, Lohse, CM, Leibovich, BC, Fergany, A, Frank, I, Gill, IS, Campbell, SC & Blute, ML 2010, 'Comparison of warm ischemia versus no ischemia during partial nephrectomy on a solitary kidney', European Urology, vol. 58, no. 3, pp. 331-336. https://doi.org/10.1016/j.eururo.2010.05.048
Thompson, R. Houston ; Lane, Brian R. ; Lohse, Christine M. ; Leibovich, Bradley C. ; Fergany, Amr ; Frank, Igor ; Gill, Inderbir S. ; Campbell, Steven C. ; Blute, Michael L. / Comparison of warm ischemia versus no ischemia during partial nephrectomy on a solitary kidney. In: European Urology. 2010 ; Vol. 58, No. 3. pp. 331-336.
@article{dfdbc140eb8c457e97942b2d9354a757,
title = "Comparison of warm ischemia versus no ischemia during partial nephrectomy on a solitary kidney",
abstract = "Background: The safe duration of warm ischemia during partial nephrectomy (PN) remains controversial. Objective: To compare the short- and long-term renal effects of warm ischemia versus no ischemia in patients with a solitary kidney. Design, setting, and participants: Using the Cleveland Clinic and Mayo Clinic databases, we identified 458 patients who underwent open (n = 411) or laparoscopic (n = 47) PN for a renal mass in a solitary kidney between 1990 and 2008. Patients treated with cold ischemia were excluded. Measurements: Associations of ischemia type (none vs warm) with short- and long-term renal function were evaluated using logistic or Cox regression models. Results and limitations: No ischemia was used in 96 patients (21{\%}), while 362 patients (79{\%}) had a median of 21 min (range: 4-55) of warm ischemia. Patients treated with warm ischemia had a significantly higher preoperative glomerular filtration rate (GFR; median: 61 ml/min per 1.73 m2 vs 54 ml/min per 1.73 m 2; p < 0.001) and larger tumors (median: 3.4 cm vs 2.5 cm; p < 0.001) compared with patients treated with no ischemia. Warm ischemia patients were significantly more likely to develop acute renal failure (odds ratio [OR]: 2.1; p = 0.044) and a GFR <15 ml/min per 1.73 m2 in the postoperative period (OR: 4.2; p = 0.007) compared with patients who did not have hilar clamping. Among the 297 patients with a preoperative GFR ≥30 ml/min per 1.73 m2, patients with warm ischemia were significantly more likely to develop new-onset stage IV chronic kidney disease (hazard ratio: 2.3; p = 0.028) during a mean follow-up of 3.3 yr. Similar results were obtained adjusting for preoperative GFR, tumor size, and type of PN in a multivariable analysis. Limitations include surgeon selection bias when determining type of ischemia. Conclusions: Warm ischemia during PN is associated with adverse renal consequences. Although selection bias is present, PN without ischemia should be used when technically feasible in patients with a solitary kidney.",
keywords = "Ischemia, Kidney neoplasms, Nephrectomy, Postoperative complications, Warm ischemia",
author = "Thompson, {R. Houston} and Lane, {Brian R.} and Lohse, {Christine M.} and Leibovich, {Bradley C.} and Amr Fergany and Igor Frank and Gill, {Inderbir S.} and Campbell, {Steven C.} and Blute, {Michael L.}",
year = "2010",
month = "9",
doi = "10.1016/j.eururo.2010.05.048",
language = "English (US)",
volume = "58",
pages = "331--336",
journal = "European Urology",
issn = "0302-2838",
publisher = "Elsevier",
number = "3",

}

TY - JOUR

T1 - Comparison of warm ischemia versus no ischemia during partial nephrectomy on a solitary kidney

AU - Thompson, R. Houston

AU - Lane, Brian R.

AU - Lohse, Christine M.

AU - Leibovich, Bradley C.

AU - Fergany, Amr

AU - Frank, Igor

AU - Gill, Inderbir S.

AU - Campbell, Steven C.

AU - Blute, Michael L.

PY - 2010/9

Y1 - 2010/9

N2 - Background: The safe duration of warm ischemia during partial nephrectomy (PN) remains controversial. Objective: To compare the short- and long-term renal effects of warm ischemia versus no ischemia in patients with a solitary kidney. Design, setting, and participants: Using the Cleveland Clinic and Mayo Clinic databases, we identified 458 patients who underwent open (n = 411) or laparoscopic (n = 47) PN for a renal mass in a solitary kidney between 1990 and 2008. Patients treated with cold ischemia were excluded. Measurements: Associations of ischemia type (none vs warm) with short- and long-term renal function were evaluated using logistic or Cox regression models. Results and limitations: No ischemia was used in 96 patients (21%), while 362 patients (79%) had a median of 21 min (range: 4-55) of warm ischemia. Patients treated with warm ischemia had a significantly higher preoperative glomerular filtration rate (GFR; median: 61 ml/min per 1.73 m2 vs 54 ml/min per 1.73 m 2; p < 0.001) and larger tumors (median: 3.4 cm vs 2.5 cm; p < 0.001) compared with patients treated with no ischemia. Warm ischemia patients were significantly more likely to develop acute renal failure (odds ratio [OR]: 2.1; p = 0.044) and a GFR <15 ml/min per 1.73 m2 in the postoperative period (OR: 4.2; p = 0.007) compared with patients who did not have hilar clamping. Among the 297 patients with a preoperative GFR ≥30 ml/min per 1.73 m2, patients with warm ischemia were significantly more likely to develop new-onset stage IV chronic kidney disease (hazard ratio: 2.3; p = 0.028) during a mean follow-up of 3.3 yr. Similar results were obtained adjusting for preoperative GFR, tumor size, and type of PN in a multivariable analysis. Limitations include surgeon selection bias when determining type of ischemia. Conclusions: Warm ischemia during PN is associated with adverse renal consequences. Although selection bias is present, PN without ischemia should be used when technically feasible in patients with a solitary kidney.

AB - Background: The safe duration of warm ischemia during partial nephrectomy (PN) remains controversial. Objective: To compare the short- and long-term renal effects of warm ischemia versus no ischemia in patients with a solitary kidney. Design, setting, and participants: Using the Cleveland Clinic and Mayo Clinic databases, we identified 458 patients who underwent open (n = 411) or laparoscopic (n = 47) PN for a renal mass in a solitary kidney between 1990 and 2008. Patients treated with cold ischemia were excluded. Measurements: Associations of ischemia type (none vs warm) with short- and long-term renal function were evaluated using logistic or Cox regression models. Results and limitations: No ischemia was used in 96 patients (21%), while 362 patients (79%) had a median of 21 min (range: 4-55) of warm ischemia. Patients treated with warm ischemia had a significantly higher preoperative glomerular filtration rate (GFR; median: 61 ml/min per 1.73 m2 vs 54 ml/min per 1.73 m 2; p < 0.001) and larger tumors (median: 3.4 cm vs 2.5 cm; p < 0.001) compared with patients treated with no ischemia. Warm ischemia patients were significantly more likely to develop acute renal failure (odds ratio [OR]: 2.1; p = 0.044) and a GFR <15 ml/min per 1.73 m2 in the postoperative period (OR: 4.2; p = 0.007) compared with patients who did not have hilar clamping. Among the 297 patients with a preoperative GFR ≥30 ml/min per 1.73 m2, patients with warm ischemia were significantly more likely to develop new-onset stage IV chronic kidney disease (hazard ratio: 2.3; p = 0.028) during a mean follow-up of 3.3 yr. Similar results were obtained adjusting for preoperative GFR, tumor size, and type of PN in a multivariable analysis. Limitations include surgeon selection bias when determining type of ischemia. Conclusions: Warm ischemia during PN is associated with adverse renal consequences. Although selection bias is present, PN without ischemia should be used when technically feasible in patients with a solitary kidney.

KW - Ischemia

KW - Kidney neoplasms

KW - Nephrectomy

KW - Postoperative complications

KW - Warm ischemia

UR - http://www.scopus.com/inward/record.url?scp=77955518229&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77955518229&partnerID=8YFLogxK

U2 - 10.1016/j.eururo.2010.05.048

DO - 10.1016/j.eururo.2010.05.048

M3 - Article

C2 - 20557996

AN - SCOPUS:77955518229

VL - 58

SP - 331

EP - 336

JO - European Urology

JF - European Urology

SN - 0302-2838

IS - 3

ER -