Every minute counts when the renal hilum is clamped during partial nephrectomy

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

Research output: Contribution to journalArticle

452 Scopus citations

Abstract

Background: The safe duration of warm ischemia during partial nephrectomy remains controversial. Objective: Our aim was to evaluate the short- and long-term renal effects of warm ischemia in patients with a solitary kidney. Design, setting, and participants: Using the Cleveland Clinic and Mayo Clinic databases, we identified 362 patients with a solitary kidney who underwent open (n = 319) or laparoscopic (n = 43) partial nephrectomy using warm ischemia with hilar clamping. Measurements: Associations of warm ischemia time with renal function were evaluated using logistic or Cox regression models first as a continuous variable and then in 5-min increments. Results and limitations: Median tumor size was 3.4 cm (range: 0.7-18.0 cm), and median ischemia time was 21 min (range: 4-55 min). Postoperative acute renal failure (ARF) occurred in 70 patients (19%) including 58 (16%) who had a glomerular filtration rate (GFR) <15 ml/min per 1.73 m2 within 30 d of surgery. Among the 226 patients with a preoperative GFR ≥ 30 ml/min per 1.73 m2 and followed ≥30 d, 38 (17%) developed new-onset stage IV chronic kidney disease during follow-up. As a continuous variable, longer warm ischemia time was associated with ARF (odds ratio: 1.05 for each 1-min increase; p < 0.001) and a GFR < 15 (odds ratio: 1.06; p < 0.001) in the postoperative period, and it was associated with new-onset stage IV chronic kidney disease (hazard ratio: 1.06; p < 0.001) during follow-up. Similar results were obtained adjusting for preoperative GFR, tumor size, and type of partial nephrectomy in a multivariable analysis. Evaluating warm ischemia in 5-min increments, a cut point of 25 min provided the best distinction between patients with and without all three of the previously mentioned end points. Limitations include the retrospective nature of the study. Conclusions: Longer warm ischemia time is associated with short- and long-term renal consequences. These results suggest that every minute counts when the renal hilum is clamped.

Original languageEnglish (US)
Pages (from-to)340-345
Number of pages6
JournalEuropean urology
Volume58
Issue number3
DOIs
StatePublished - Sep 1 2010

Keywords

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

ASJC Scopus subject areas

  • Urology

Fingerprint Dive into the research topics of 'Every minute counts when the renal hilum is clamped during partial nephrectomy'. Together they form a unique fingerprint.

  • Cite this

    Thompson, R. H., Lane, B. R., Lohse, C. M., Leibovich, B. C., Fergany, A., Frank, I., Gill, I. S., Blute, M. L., & Campbell, S. C. (2010). Every minute counts when the renal hilum is clamped during partial nephrectomy. European urology, 58(3), 340-345. https://doi.org/10.1016/j.eururo.2010.05.047