1110 FUNCTIONAL RECOVERY AFTER PARTIAL NEPHRECTOMY EFFECTS OF VOLUME LOSS AND ISCHEMIC INJURY

Abstract

You have accessJournal of UrologyKidney Cancer: Localized I1 Apr 20121110 FUNCTIONAL RECOVERY AFTER PARTIAL NEPHRECTOMY EFFECTS OF VOLUME LOSS AND ISCHEMIC INJURY Matthew Simmons, Shahab Hillyer, Byron Lee, Amr Fergany, Jihad Kaouk, and Steven Campbell Matthew SimmonsMatthew Simmons Cleveland, OH More articles by this author , Shahab HillyerShahab Hillyer Cleveland, OH More articles by this author , Byron LeeByron Lee Cleveland, OH More articles by this author , Amr FerganyAmr Fergany Cleveland, OH More articles by this author , Jihad KaoukJihad Kaouk Cleveland, OH More articles by this author , and Steven CampbellSteven Campbell Cleveland, OH More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1218AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES This study used a new method to estimate volume loss after partial nephrectomy (PN) to assess the relative contributions of ischemic injury and volume loss on functional outcomes. METHODS Analysis was conducted for 301 consecutive patients who underwent conventional PN between 2007 and 2010 with available data to meet inclusion criteria. Percent functional volume preservation (PFVP) was measured at a median of 1.4 years after surgery. MDRD-2 estimated GFR was measured pre- and perioperatively, and at a median of 1.2 years after PN. Statistical analyses were conducted to study associations. RESULTS Hypothermia or warm ischemia ≤25 minutes were applied in 75% of cases. Median PFVP was 91% (range: 38-107%). Percent GFR preservation (PGP) at nadir and late time points was 77% and 90% of preoperative GFR, respectively. In multivariate analysis PFVP and warm ischemia time (WIT) associated with nadir GFR (p<0.001), while only PFVP associated with late GFR (p<0.001). Late PGP and PFVP were directly associated (p<0.001). Recovery of function to ≥90% of PFVP-adjusted levels was observed in 86% of patients. In patients with de novo postoperative stage ≥3 CKD, PFVP and Charlson score were associated with late PGP. WIT was not associated with late functional GFR decreases in patients considered high risk for ischemic injury. CONCLUSIONS In this cohort volume loss, and not ischemia time, was the primary determinant of ultimate renal function after PN. Technical modifications aimed at minimizing volume loss during PN while still achieving negative margins may result in improved functional outcomes. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e450 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matthew Simmons Cleveland, OH More articles by this author Shahab Hillyer Cleveland, OH More articles by this author Byron Lee Cleveland, OH More articles by this author Amr Fergany Cleveland, OH More articles by this author Jihad Kaouk Cleveland, OH More articles by this author Steven Campbell Cleveland, OH More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...