MP44-09 DOES WARM ISCHEMIC TIME REALLY AFFECT THE LATE KIDNEY FUNCTION AND OVERALL SURVIVAL AFTER PARTIAL NEPHRECTOMY?

Abstract

You have accessJournal of UrologyKidney Cancer: Evaluation and Staging II1 Apr 2015MP44-09 DOES WARM ISCHEMIC TIME REALLY AFFECT THE LATE KIDNEY FUNCTION AND OVERALL SURVIVAL AFTER PARTIAL NEPHRECTOMY? Jae Seung Chung, Seok-Soo Byun, Sang Eun Lee, Sung Kyu Hong, Sang Chul Lee, Cheol Kwak, Sung Hoo Hong, Yong June Kim, and Seok-Ho Kang Jae Seung ChungJae Seung Chung More articles by this author , Seok-Soo ByunSeok-Soo Byun More articles by this author , Sang Eun LeeSang Eun Lee More articles by this author , Sung Kyu HongSung Kyu Hong More articles by this author , Sang Chul LeeSang Chul Lee More articles by this author , Cheol KwakCheol Kwak More articles by this author , Sung Hoo HongSung Hoo Hong More articles by this author , Yong June KimYong June Kim More articles by this author , and Seok-Ho KangSeok-Ho Kang More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1551AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We evaluate longitudinal changes in renal function according to warm ischemic time (WIT) after partial nephrectomy (PN). METHODS The study population consisted of 1416 consecutive patients who were treated at multiple institutions by PN for renal cortical tumor between 1999 and 2011. We excluded the patients with preoperative eGFR less than 60 mL/min/1.73m2. To investigate the effect of warm ischemia on kidney function and overall survival (OS) according to ischemia time, we divided the patients into two subgroups (Group A: 0≤WIT< 20, Group B: 20≤WIT). To account for inherent differences between the groups, we used propensity score matching to adjust for age, gender, tumor size, comorbidities (diabetes, hypertension), and preoperative kidney function (eGFR). We measured the serial change in estimated glomerular filtration rate (eGFR) during a 5-year follow-up period. The changes in eGFR over time from 9 month after surgery were analyzed using a general linear model. The independent prognostic value of WIT on the last postoperative eGFR was ascertained by multivariate regression model. The probabilities of freedom from chronic kidney disease (CKD stage III) and 5-year OS were estimated using the Kaplan-Meier method. RESULTS After propensity matching, 339 group A patients were matched with 339 group B patients. The median follow-up duration in the group A and B was 41.2 and 39.8 months, respectively. Overall, there was a subsequent decrease in renal function to the 9 months after PN in both groups. However, renal function recovered from 12months after surgery in group A. Kidney function was significantly better preserved in the group A than in the group B. The slopes for the relationship between the eGFR and time since PN were 0.1871 (95% confidence interval [CI], 0.092 – 0.247; P=0.023) and 0.0037 (95% CI, -0.076 – 0.084; P=0.921) in both group, respectively. WIT was a significant prognostic factor for predicting the last postoperative eGFR in multivariate analysis. The probabilities of freedom from CKD III after PN were 95.9% for group A versus 92.6% for group B (p=0.017). The 5-year OS rates were 99.7% for group A versus 97.9% for group B (p=0.030). CONCLUSIONS Our data suggest that WIT have an effect on late kidney function. In addition, short duration of WIT (0≤WIT<20) did lead to better overall survival rate. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e529-e530 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jae Seung Chung More articles by this author Seok-Soo Byun More articles by this author Sang Eun Lee More articles by this author Sung Kyu Hong More articles by this author Sang Chul Lee More articles by this author Cheol Kwak More articles by this author Sung Hoo Hong More articles by this author Yong June Kim More articles by this author Seok-Ho Kang More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...