Mp36-17 Renal Functional Improvement After Partial Nephrectomy: Predictors and Consequences

You have accessJournal of UrologyKidney Cancer: Epidemiology & Evaluation/Staging/Surveillance I (MP36)1 May 2024MP36-17 RENAL FUNCTIONAL IMPROVEMENT AFTER PARTIAL NEPHRECTOMY: PREDICTORS AND CONSEQUENCES Kit L. Yuen, Cesare Saitta, Yasuhisa Fujii, Edouard Nicaise, Riccardo Autorino, Andrea Minervini, Gabriele Tuderti, Giuseppe Simone, Riccardo Campi, Clara Cerrato, Antonio Franco, Dhruv Puri, Mimi V. Nguyen, Margaret Meagher, Jacob Roberts, Jonathan A. Afari, Luke Wang, Kevin Hakimi, Franklin Liu, Rachel Greenwald, Chen Wei, Sahar Imtiaz, Dattatraya Patil, Kobayashi Masaki, Kazutaka Saito, Fukuda Shohei, Hajime Tanaka, Viraj Master, and Ithaar H. Derweesh Kit L. YuenKit L. Yuen , Cesare SaittaCesare Saitta , Yasuhisa FujiiYasuhisa Fujii , Edouard NicaiseEdouard Nicaise , Riccardo AutorinoRiccardo Autorino , Andrea MinerviniAndrea Minervini , Gabriele TudertiGabriele Tuderti , Giuseppe SimoneGiuseppe Simone , Riccardo CampiRiccardo Campi , Clara CerratoClara Cerrato , Antonio FrancoAntonio Franco , Dhruv PuriDhruv Puri , Mimi V. NguyenMimi V. Nguyen , Margaret MeagherMargaret Meagher , Jacob RobertsJacob Roberts , Jonathan A. AfariJonathan A. Afari , Luke WangLuke Wang , Kevin HakimiKevin Hakimi , Franklin LiuFranklin Liu , Rachel GreenwaldRachel Greenwald , Chen WeiChen Wei , Sahar ImtiazSahar Imtiaz , Dattatraya PatilDattatraya Patil , Kobayashi MasakiKobayashi Masaki , Kazutaka SaitoKazutaka Saito , Fukuda ShoheiFukuda Shohei , Hajime TanakaHajime Tanaka , Viraj MasterViraj Master , and Ithaar H. DerweeshIthaar H. Derweesh View All Author Informationhttps://doi.org/10.1097/01.JU.0001008612.93052.9d.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Partial nephrectomy (PN) has emerged as the reference standard for localized renal mass management due superior functional preservation over radical nephrectomy. A proportion of patients experience renal function improvement post-PN. We sought to identify and characterize factors contributing to this phenomenon. METHODS: This was a retrospective multicenter analysis of patients who underwent open or minimally invasive (MIS) PN. Post-PN functional improvement was defined as eGFR ≥10% of preoperative baseline at last follow-up. Cox regression multivariable analysis (MVA) was performed to identify factors associated with improved function and non-cancer mortality (NCM). Kaplan-Meier analysis (KMA) assessed non-cancer specific survival (NCS) comparing eGFR≥10%, GFR improvement less than 10%/decline greater than 25% (+10%<ΔGFR<-25%), and eGFR decline>25% (ΔGFR>-25%). RESULTS: We analyzed 3,845 patients [1,535 (39.9%) female/2,310 (59.2%) male; median follow-up 48.2 months]. Improved eGFR was noted in 626 (16.3%). Clear cell RCC (cc RCC; HR 1.46, p=0.038), and clampless technique (HR 1.43, p=0.018) were associated with greater likelihood of eGFR≥10%. Increasing age (HR 0.93, p=0.001), diabetes mellitus (HR\ 0.071, p=0.012), MIS (HR 0.76, p=0.009), increasing Charlson comorbidity index (HR 0.92, p=0.019), decreasing preoperative eGFR (HR 0.97, p<0.001) and increasing tumor size (HR 0.92, p=0.002) had decreased likelihood of eGFR≥10%. Cox regression revealed eGFR≥10% (HR 0.54, p=0.006), Latino and Asian ethnicity (HR 0.41, p=0.001-0.021) to be associated with decreased NCM, while increasing age (HR 1.03, p<0.001), male (HR 1.63, p=0.002), and DM (HR 1.42, p=0.014) were associated with increased NCM. KMA comparing eGFR≥10%, +10%<∆GFR<-25%, and ∆GFR>-25% revealed 5-year NCS of 95.5%, 96.1%, and 93.2%, respectively (p=0.0001). CONCLUSIONS: A small but significant proportion of patients experience improved eGFR post-PN; eGFR improvement was associated with decreased NCM risk. When feasible and safe, clampless technique may optimize functional preservation and recovery leading to improved function and NCM reduction in select patients. Improvement after ccRCC excision suggests impact of tumor histology-driven renal microenvironment on function. Further investigation is requisite. Download PPT Source of Funding: N/A © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e599 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Kit L. Yuen More articles by this author Cesare Saitta More articles by this author Yasuhisa Fujii More articles by this author Edouard Nicaise More articles by this author Riccardo Autorino More articles by this author Andrea Minervini More articles by this author Gabriele Tuderti More articles by this author Giuseppe Simone More articles by this author Riccardo Campi More articles by this author Clara Cerrato More articles by this author Antonio Franco More articles by this author Dhruv Puri More articles by this author Mimi V. Nguyen More articles by this author Margaret Meagher More articles by this author Jacob Roberts More articles by this author Jonathan A. Afari More articles by this author Luke Wang More articles by this author Kevin Hakimi More articles by this author Franklin Liu More articles by this author Rachel Greenwald More articles by this author Chen Wei More articles by this author Sahar Imtiaz More articles by this author Dattatraya Patil More articles by this author Kobayashi Masaki More articles by this author Kazutaka Saito More articles by this author Fukuda Shohei More articles by this author Hajime Tanaka More articles by this author Viraj Master More articles by this author Ithaar H. Derweesh More articles by this author Expand All Advertisement PDF downloadLoading ...