The Impact of Ischemia Time During Open Nephron Sparing Surgery on Solitary Kidneys: A Multi-Institutional Study

R. Houston Thompson, Igor Frank, Christine M. Lohse, Ismail R. Saad, Amr Fergany, Horst Zincke, Bradley C. Leibovich, Michael L. Blute, Andrew C. Novick

Research output: Contribution to journalArticle

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Abstract

Purpose: The safe duration of ischemia during nephron sparing surgery remains controversial. We performed a multi-institutional study to evaluate the renal effects of vascular clamping in patients with solitary kidneys. Materials and Methods: Using the Cleveland Clinic and Mayo Clinic databases, we identified 537 patients with solitary kidneys who underwent open nephron sparing surgery. Renal complications were compared among patients who did not require vascular clamping (85), and those who had warm ischemia (174) and cold ischemia (278). Results: Median patient age (63, 65, 64 years) and preoperative creatinine (1.4, 1.3, 1.4 mg/dl) were similar among patients with no ischemia, warm ischemia and cold ischemia, respectively. Median tumor size was smaller in patients with no ischemia (2.5 cm), compared to patients with warm (3.5 cm) and cold (4.0 cm) ischemia (p <0.001). Warm and cold ischemia was associated with a significantly increased risk of urine leak (p = 0.006), acute (p <0.001) and chronic (p = 0.027) renal failure, and temporary dialysis (p = 0.028) compared to patients with no ischemia. Warm ischemia longer than 20 minutes and cold ischemia longer than 35 minutes were associated with a higher incidence of acute renal failure (p = 0.002 and p = 0.003, respectively). Additionally, warm ischemia more than 20 minutes was associated with an increased risk of chronic renal insufficiency (41% vs 19%, p = 0.008), increase in creatinine greater than 0.5 (42% vs 15%, p <0.001) and permanent dialysis (10% vs 4%, p = 0.145). Conclusions: Vascular clamping during open nephron sparing surgery is associated with a higher incidence of renal complications. Attempts to limit warm ischemia to 20 minutes and cold ischemia to 35 minutes should be used when vascular clamping is necessary.

Original languageEnglish (US)
Pages (from-to)471-476
Number of pages6
JournalJournal of Urology
Volume177
Issue number2
DOIs
StatePublished - Feb 2007

Fingerprint

Nephrons
Warm Ischemia
Cold Ischemia
Ischemia
Kidney
Constriction
Blood Vessels
Dialysis
Creatinine
Incidence
Chronic Renal Insufficiency
Acute Kidney Injury
Renal Insufficiency
Urine
Databases

Keywords

  • cold ischemia
  • kidney neoplasms
  • nephrectomy
  • postoperative complications
  • warm ischemia

ASJC Scopus subject areas

  • Urology

Cite this

Thompson, R. H., Frank, I., Lohse, C. M., Saad, I. R., Fergany, A., Zincke, H., ... Novick, A. C. (2007). The Impact of Ischemia Time During Open Nephron Sparing Surgery on Solitary Kidneys: A Multi-Institutional Study. Journal of Urology, 177(2), 471-476. https://doi.org/10.1016/j.juro.2006.09.036

The Impact of Ischemia Time During Open Nephron Sparing Surgery on Solitary Kidneys : A Multi-Institutional Study. / Thompson, R. Houston; Frank, Igor; Lohse, Christine M.; Saad, Ismail R.; Fergany, Amr; Zincke, Horst; Leibovich, Bradley C.; Blute, Michael L.; Novick, Andrew C.

In: Journal of Urology, Vol. 177, No. 2, 02.2007, p. 471-476.

Research output: Contribution to journalArticle

Thompson, RH, Frank, I, Lohse, CM, Saad, IR, Fergany, A, Zincke, H, Leibovich, BC, Blute, ML & Novick, AC 2007, 'The Impact of Ischemia Time During Open Nephron Sparing Surgery on Solitary Kidneys: A Multi-Institutional Study', Journal of Urology, vol. 177, no. 2, pp. 471-476. https://doi.org/10.1016/j.juro.2006.09.036
Thompson, R. Houston ; Frank, Igor ; Lohse, Christine M. ; Saad, Ismail R. ; Fergany, Amr ; Zincke, Horst ; Leibovich, Bradley C. ; Blute, Michael L. ; Novick, Andrew C. / The Impact of Ischemia Time During Open Nephron Sparing Surgery on Solitary Kidneys : A Multi-Institutional Study. In: Journal of Urology. 2007 ; Vol. 177, No. 2. pp. 471-476.
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abstract = "Purpose: The safe duration of ischemia during nephron sparing surgery remains controversial. We performed a multi-institutional study to evaluate the renal effects of vascular clamping in patients with solitary kidneys. Materials and Methods: Using the Cleveland Clinic and Mayo Clinic databases, we identified 537 patients with solitary kidneys who underwent open nephron sparing surgery. Renal complications were compared among patients who did not require vascular clamping (85), and those who had warm ischemia (174) and cold ischemia (278). Results: Median patient age (63, 65, 64 years) and preoperative creatinine (1.4, 1.3, 1.4 mg/dl) were similar among patients with no ischemia, warm ischemia and cold ischemia, respectively. Median tumor size was smaller in patients with no ischemia (2.5 cm), compared to patients with warm (3.5 cm) and cold (4.0 cm) ischemia (p <0.001). Warm and cold ischemia was associated with a significantly increased risk of urine leak (p = 0.006), acute (p <0.001) and chronic (p = 0.027) renal failure, and temporary dialysis (p = 0.028) compared to patients with no ischemia. Warm ischemia longer than 20 minutes and cold ischemia longer than 35 minutes were associated with a higher incidence of acute renal failure (p = 0.002 and p = 0.003, respectively). Additionally, warm ischemia more than 20 minutes was associated with an increased risk of chronic renal insufficiency (41{\%} vs 19{\%}, p = 0.008), increase in creatinine greater than 0.5 (42{\%} vs 15{\%}, p <0.001) and permanent dialysis (10{\%} vs 4{\%}, p = 0.145). Conclusions: Vascular clamping during open nephron sparing surgery is associated with a higher incidence of renal complications. Attempts to limit warm ischemia to 20 minutes and cold ischemia to 35 minutes should be used when vascular clamping is necessary.",
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AU - Saad, Ismail R.

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AU - Zincke, Horst

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AB - Purpose: The safe duration of ischemia during nephron sparing surgery remains controversial. We performed a multi-institutional study to evaluate the renal effects of vascular clamping in patients with solitary kidneys. Materials and Methods: Using the Cleveland Clinic and Mayo Clinic databases, we identified 537 patients with solitary kidneys who underwent open nephron sparing surgery. Renal complications were compared among patients who did not require vascular clamping (85), and those who had warm ischemia (174) and cold ischemia (278). Results: Median patient age (63, 65, 64 years) and preoperative creatinine (1.4, 1.3, 1.4 mg/dl) were similar among patients with no ischemia, warm ischemia and cold ischemia, respectively. Median tumor size was smaller in patients with no ischemia (2.5 cm), compared to patients with warm (3.5 cm) and cold (4.0 cm) ischemia (p <0.001). Warm and cold ischemia was associated with a significantly increased risk of urine leak (p = 0.006), acute (p <0.001) and chronic (p = 0.027) renal failure, and temporary dialysis (p = 0.028) compared to patients with no ischemia. Warm ischemia longer than 20 minutes and cold ischemia longer than 35 minutes were associated with a higher incidence of acute renal failure (p = 0.002 and p = 0.003, respectively). Additionally, warm ischemia more than 20 minutes was associated with an increased risk of chronic renal insufficiency (41% vs 19%, p = 0.008), increase in creatinine greater than 0.5 (42% vs 15%, p <0.001) and permanent dialysis (10% vs 4%, p = 0.145). Conclusions: Vascular clamping during open nephron sparing surgery is associated with a higher incidence of renal complications. Attempts to limit warm ischemia to 20 minutes and cold ischemia to 35 minutes should be used when vascular clamping is necessary.

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KW - kidney neoplasms

KW - nephrectomy

KW - postoperative complications

KW - warm ischemia

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