Effect of Warm Ischemia Time During Laparoscopic Partial Nephrectomy on Early Postoperative Glomerular Filtration Rate

Godoy, Guilherme; Ramanathan, Vigneshwaran; Kanofsky, Jamie A.; O’Malley, Rebecca L.; Tareen, Basir; Taneja, Samir S.; Stifelman, Michael

doi:10.1016/j.juro.2009.02.026

Cited by 104 publications

(56 citation statements)

References 17 publications

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“…8,9 Multiple studies have previously demonstrated that prolonged warm ischemia time (WIT) during PN causes residual renal tissue injury, is severely detrimental to postoperative renal function and can result in new onset chronic kidney disease (CKD). [10][11][12] Recently, small endogenously produced gaseous molecules, called gasotransmitters, have been shown to exert protective effects against tissue IRI. Hydrogen sulfide (H 2 S) is the most recently characterized member of the gasotransmitter family, along with nitric oxide (NO) and carbon monoxide (CO), and has been the subject of increased interest due to its significant protective effects against tissue IRI.…”

Section: Introductionmentioning

confidence: 99%

Hydrogen sulfide treatment improves long-term renal dysfunction resulting from prolonged warm renal ischemia-reperfusion injury

Lobb

Zhu

Liu

et al. 2014

CUAJ

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Section: Introductionmentioning

confidence: 99%

Hydrogen sulfide treatment improves long-term renal dysfunction resulting from prolonged warm renal ischemia-reperfusion injury

Lobb

Zhu

Liu

et al. 2014

CUAJ

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“…Some studies based on creatinine or estimated glomerular filtration rate (eGFR) suggest that WIT should be kept under 20 minutes, while others have suggested 40 minutes as a cut-off. [5][6][7][8][9][10][11] This discrepancy between studies underscores the Multivariate analysis of the factors involved in loss of renal differential function after laparoscopic partial nephrectomy: a role for warm ischemia time need for homogenous data using RF tools that evaluate the damage to the operated kidney.…”

Section: Introductionmentioning

confidence: 99%

Multivariate analysis of the factors involved in loss of renal differential function after laparoscopic partial nephrectomy: a role for warm ischemia time

Pouliot

Imbeault

Shuch

et al. 2013

CUAJ

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Background: Partial nephrectomy (PN) is now the gold standard for the surgical treatment of small renal masses. We evaluated the effect of WIT and other factors on RDF assessed by preoperative and postoperative renal scintigraphy. Methods: Between 2003 and 2008, 182 consecutive laparoscopic PN (LPN) were performed in an academic centre. Among those, 56 had mercaptoacetyl triglycine (MAG3) lasix renal scintigraphy preoperatively and postoperatively. Results: Medians for age, preoperative estimated glomerular filtration rate and computed tomography scan tumour size were 62 years, 82 mL/min/1.73m 2 and 26 mm, respectively. Median WIT and preoperative RDF were 30 minutes and 50%, respectively. Median loss of RDF after surgery was 14%. Linear regression curves showed that loss in RDF rate was 0.2% per minute when WIT was <30 minutes and 0.7% per minute when WIT was ≥30 minutes. In multivariate analysis, length of WIT and endophytic tumour location were associated with a statistically significant loss of RDF (p < 0.05), but only in the group who experienced >30 minutes of WIT. Interpretation: Our results suggest that the factors associated with loss of RDF are not the same before and after 30 minutes of WIT and that the rate of loss in RDF increases after 30 minutes. Since, the effect of WIT is small up to 30 minutes, we believe that surgery should focus on limiting the resection of normal parenchyma and to ensure negative margins and hemostasis, rather than on premature unclamping.

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“…18,19 Moreover, in retrospective studies, the warm ischemia of 40 to 55 minutes was safe and sufficient for the complete recovery of renal function. 20,21 Lee and colleagues demonstrated that ultimate renal function decreases proportionally with increasing ischemia time in the warm and cold ischemia groups. 22 Accordingly, we believe that our results provide information on the correlation between the anatomical features of renal tumours and the functional outcomes of RAPN.…”

Section: Discussionmentioning

confidence: 99%

The association between the anatomical features of renal tumours and the functional outcomes of robot-assisted partial nephrectomy

Lee

Cho

Jeon

et al. 2014

CUAJ

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Cite as: Can Urol Assoc J 2014;8(11-12):e810-4. http://dx.doi.org/10.5489/cuaj.1642 Published online November 24, 2014. AbstractIntroduction: We evaluated the the association between PADUA scores and postoperative renal function (after robot-assisted partial nephrectomy [RAPN]) and between PADUA scores and warm ischemic time (during RAPN). Methods: We reviewed the clinical records of 106 patients who underwent RAPN for a single localized renal tumour between April 2009 and June 2012. Postoperative renal function was evaluated using estimated glomerular filtration rate (eGFR) in 85 patients who were followed for at least 6 months. PADUA scores for renal tumours were calculated using contrast-enhanced computed tomography images, if needed, along with magnetic resonance images in some cases. Results: A PADUA score ≥10 and WIT ≥30 minutes were observed in 18 (17.0%) and 51 (48.1%) cases, respectively. PADUA scores were significantly correlated with WIT (p = 0.019) and percent change in eGFR at 6 months postoperatively (p = 0.005). PADUA score (continuous variable, odds ratio [OR] 1.694, p = 0.007) and the high-risk group (PADUA score ≥10) (OR 5.429; p = 0.020) were significantly associated with a WIT of ≥30 minutes by multivariate analysis. A 1-point increase in the PADUA score was associated with an eGFR decrease of >20% at 6 months after RAPN (OR 1.799; p = 0.076). In addition, a PADUA score ≥10, or high risk, (OR 13.965; p = 0.003) was an independent predictor of an eGFR decrease of >20% at 6 months after RAPN. Conclusions: The PADUA classification can reliably predict WIT and postoperative renal functional outcome after RAPN. Furthermore, the study suggests that anatomical aspects of renal tumours are associated with functional outcome after RAPN.

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Effect of Warm Ischemia Time During Laparoscopic Partial Nephrectomy on Early Postoperative Glomerular Filtration Rate

Cited by 104 publications

References 17 publications

Hydrogen sulfide treatment improves long-term renal dysfunction resulting from prolonged warm renal ischemia-reperfusion injury

Hydrogen sulfide treatment improves long-term renal dysfunction resulting from prolonged warm renal ischemia-reperfusion injury

Multivariate analysis of the factors involved in loss of renal differential function after laparoscopic partial nephrectomy: a role for warm ischemia time

The association between the anatomical features of renal tumours and the functional outcomes of robot-assisted partial nephrectomy

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