Comparison of Warm Ischemia Versus No Ischemia During Partial Nephrectomy on a Solitary Kidney

Abstract Background The safe duration of warm ischemia during partial nephrectomy (PN) remains controversial. Objective To compare the short- and long-term renal effects of warm ischemia versus no ischemia in patients with a solitary kidney. Design, setting, and participants Using the Cleveland Clinic and Mayo Clinic databases, we identified 458 patients who underwent open ( n = 411) or laparoscopic ( n = 47) PN for a renal mass in a solitary kidney between 1990 and 2008. Patients treated with cold ischemia were excluded. Measurements Associations of ischemia type (none vs warm) with short- and long-term renal function were evaluated using logistic or Cox regression models. Results and limitations No ischemia was used in 96 patients (21%), while 362 patients (79%) had a median of 21 min (range: 4–55) of warm ischemia. Patients treated with warm ischemia had a significantly higher preoperative glomerular filtration rate (GFR; median: 61 ml/min per 1.73 m2 vs 54 ml/min per 1.73 m2 ; p < 0.001) and larger tumors (median: 3.4 cm vs 2.5 cm; p < 0.001) compared with patients treated with no ischemia. Warm ischemia patients were significantly more likely to develop acute renal failure (odds ratio [OR]: 2.1; p = 0.044) and a GFR