Every Minute Counts When the Renal Hilum Is Clamped During Partial Nephrectomy

Abstract Background The safe duration of warm ischemia during partial nephrectomy remains controversial. Objective Our aim was to evaluate the short- and long-term renal effects of warm ischemia in patients with a solitary kidney. Design, setting, and participants Using the Cleveland Clinic and Mayo Clinic databases, we identified 362 patients with a solitary kidney who underwent open ( n = 319) or laparoscopic ( n = 43) partial nephrectomy using warm ischemia with hilar clamping. Measurements Associations of warm ischemia time with renal function were evaluated using logistic or Cox regression models first as a continuous variable and then in 5-min increments. Results and limitations Median tumor size was 3.4 cm (range: 0.7–18.0 cm), and median ischemia time was 21 min (range: 4–55 min). Postoperative acute renal failure (ARF) occurred in 70 patients (19%) including 58 (16%) who had a glomerular filtration rate (GFR)