1Department of Urology, Clinical Center of University Heidelberg, Heidelberg 999035, Germany; 2Department of Urology, General Hospital of PLA, China; 3Department of Epidemiology and Biostatistics, School of Public Health Beijing University, China; 4Kidney Center, Clinical Center of University Heidelberg, Germany
Abstract：Objective:The effects of warm ischemia time on long-term renal function after partial nephrectomy remain controversial. Our aim was to evaluate the effect of warm ischemia time on long-term renal function after partial nephrectomy. Methods:A retrospective study was performed on 75 patients undergoing 83 procedures of partial nephrectomy in Department of Urology of Clinical Center of University Heidelberg from 08/1984 to 07/2011. The effects of warm ischemia time, preoperative renal function and resected normal parenchyma volume on long-term renal function in patients with a solitary kidney were evaluated. Results:Mean preoperative eGFR was 57.41 mL/(min per 1.73 m2. Mean ischemia time was 18.04 min. Mean volume of resected normal parenchyma was 18.79 cm3. Mean follow-up time was 69.39 months. On multivariable analysis, adjusting for age and comorbidities factors, preoperative renal function baseline was significantly associated with renal function at 12th month postoperation (P=0.01). Perioperative ARF event significantly affected postoperative renal function at 12th month on (P=0.001) and 60th month (P=0.03) postoperation. Warm ischemia time and resected normal parenchyma volume were not risk factors of long-term postoperative renal function. The perioperative ARF event was significantly associated with renal function change at 12th month postoperation (P<0.01). Only resected volume of normal parenchyma was significantly associated with renal function change during whole follow-up period (P=0.03 at 12th month, and P<0.01 at 36th and 60th month). Conclusions:The quality and quantity of kidney were most important risk factors of long-term renal function after partial nephrectomy. The quality of preoperative kidney primarily determines long-term postoperative renal function. Additionally, the quantity of preserved functional parenchyma volume was the main determinant for long-term kidney recovery. Moreover, the acute renal failure was an independent risk factor influencing both recovery capacity and renal function level in long-term postoperative duration. Furthermore, WIT was indirectly associated with postoperative renal function leading to a higher rate of perioperative acute renal failure.
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