Mp44-03 the Impact of Ischemia Time on Renal Function in Patients With Microcirculation Impairment During Partial Nephrectomy for RCC

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy III (MP44)1 May 2024MP44-03 THE IMPACT OF ISCHEMIA TIME ON RENAL FUNCTION IN PATIENTS WITH MICROCIRCULATION IMPAIRMENT DURING PARTIAL NEPHRECTOMY FOR RCC Francesco Cei, Daniele Cignoli, Federico Belladelli, Chiara Re, Giacomo Musso, Francesco Trevisani, Arianna Bettiga, Pierre Karakiewicz, Par Stattin, Isaline Rowe, Roberta Lucianò, Giuseppe Rosiello, Daniela Canibus, Francesco Fiorio, Roberto Bertini, Andrea Salonia, Alberto Briganti, Francesco Montorsi, Alessandro Larcher, and Umberto Capitanio Francesco CeiFrancesco Cei , Daniele CignoliDaniele Cignoli , Federico BelladelliFederico Belladelli , Chiara ReChiara Re , Giacomo MussoGiacomo Musso , Francesco TrevisaniFrancesco Trevisani , Arianna BettigaArianna Bettiga , Pierre KarakiewiczPierre Karakiewicz , Par StattinPar Stattin , Isaline RoweIsaline Rowe , Roberta LucianòRoberta Lucianò , Giuseppe RosielloGiuseppe Rosiello , Daniela CanibusDaniela Canibus , Francesco FiorioFrancesco Fiorio , Roberto BertiniRoberto Bertini , Andrea SaloniaAndrea Salonia , Alberto BrigantiAlberto Briganti , Francesco MontorsiFrancesco Montorsi , Alessandro LarcherAlessandro Larcher , and Umberto CapitanioUmberto Capitanio View All Author Informationhttps://doi.org/10.1097/01.JU.0001009508.69111.d0.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In patients with microcirculation impairment elected for partial nephrectomy (PN) to treat a renal mass, arterial clamping and ischemia time (IT) might not be tolerated and increase significantly the risk of renal function detriment. The aim of the study was to investigate functional outcomes after PN in patients with microcirculation impairment. METHODS: Prospectively collected data were obtained from a cohort of 186 patients with pre-existing microcirculation impairment who underwent elective PN for cT1-2 cN0 cM0 RCC. Microcirculation impairment was defined as the presence of long-term uncontrolled hypertension and diabetes, peripheral vasculopathy, or vascular nephropathy. IT was defined as the duration of clamping of the main renal artery with no refrigeration. The primary outcome of the study was evaluation of the effect of WIT on renal function postoperatively, at 6 months and in the long term. The secondary outcome of the study was haemorrhagic risk, defined as estimated blood loss (EBL) or peri-operative transfusions. Multivariable linear, logistic and Cox regression analyses (MVA), accounting for age, Charlson comorbidity index, clinical size, preoperative eGFR and year of surgery, were used. RESULTS: 139 patients (75%) underwent PN with WIT and 47 (25%) without. The baseline median eGFR was 71 mL/min/1.73 m2 for the on-clamp population and 61.4 mL/min/1.73 m2 for the off-clamp population. At multivariable analyses predicting renal function, longer WIT was associated with decreased postoperative eGFR (Est: −0.23, p0.1). At MVA predicting haemorrhagic risk, clampless resection with no ischaemia time and PN with short WIT was associated with an increased EBL (Est: −25.77, [p=0.03) and peri-operative transfusion rate (Est: −0.017, p=0.04). CONCLUSIONS: Patients and clinicians should be aware that performing PN with very limited or even with zero WIT in patients with a pre-existing microcirculation impairment doesn't improve long-term renal function outcomes and increases bleeding and need for peri-operative transfusions. Our findings support hilum preparation and clamping even in patients with microcirculation impairment. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e731 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Francesco Cei More articles by this author Daniele Cignoli More articles by this author Federico Belladelli More articles by this author Chiara Re More articles by this author Giacomo Musso More articles by this author Francesco Trevisani More articles by this author Arianna Bettiga More articles by this author Pierre Karakiewicz More articles by this author Par Stattin More articles by this author Isaline Rowe More articles by this author Roberta Lucianò More articles by this author Giuseppe Rosiello More articles by this author Daniela Canibus More articles by this author Francesco Fiorio More articles by this author Roberto Bertini More articles by this author Andrea Salonia More articles by this author Alberto Briganti More articles by this author Francesco Montorsi More articles by this author Alessandro Larcher More articles by this author Umberto Capitanio More articles by this author Expand All Advertisement PDF downloadLoading ...