Impact of ischaemia duration and clamping strategy in patients with solitary kidney undergoing partial nephrectomy
Year: 2026
Type: article
Study design: Observational Study
Abstract: OBJECTIVES: To explore the effects of ischaemia time (IT) in a multicentre cohort of patients with solitary kidney (SK), treated with partial nephrectomy (PN) for a renal mass, on short- and long-term kidney function, haemorrhagic risk and pathological outcomes. METHODS: This is an observational study of 426 patients with SK treated with on- and off-clamp PN for a single cT1-3 N0M0 renal mass from 2000 to 2023 at 19 global institutions. The primary outcomes were postoperative and 1-year renal function. The secondary outcomes of the study were haemorrhagic risk, defined as estimated blood loss (EBL) and peri-operative transfusions, and presence of positive surgical margins. The effect of IT and arterial clamping strategy was estimated using linear and logistic regressions for continuous and categorical outcomes, respectively. RESULTS: , 58 (45-46) mL/min, 3 (2-4.2) cm and 8 (7-10), respectively. The median (IQR) duration of IT was 19 (13-25) min. In multivariable linear and logistic regression analyses (MVA), IT was not associated with decreased postoperative eGFR (estimate -0.08 mL/min; P = 0.3) or 1-year eGFR (estimate -0.1 mL/min; P = 0.2). No association between on-clamp strategy and eGFR decline was recorded either postoperatively (estimate -3.11 mL/min; P = 0.1) or at 1 year (estimate -3.12 mL/min; P = 0.1). The median (IQR) EBL was lower in the on-clamp group at 200 (100-400) mL vs 300 (145-500) mL in the off-clamp group. In MVA predicting haemorrhagic risk, arterial clamping was associated with lower risk of transfusions (odds ratio 0.45; P = 0.01). CONCLUSIONS: In patients with SK, on-clamp PN did not affect long-term renal function and was associated with a modestly lower need for peri-operative transfusion. The routine use of the off-clamp technique is therefore not supported by these findings, although its selective application may remain appropriate in cases with a high risk of renal function decline.
Source: British Journal of Urology
DOI: 10.1111/bju.70146
Authors: Francesco Cei, Daniele Cignoli, Irene Franco, Koon Ho Rha, Christian Wagner, Alexander Kutikov, James Porter, Ben Challacombe, Ketan Badani, Eduard Roussel, Riccardo Bertolo, Alessandro Antonelli, Riccardo Schiavina, Attilio Barretta, Karim Bensalah, Xu Zhang, Ithaar Derweesh, Ruben De Groote, Geert De Naeyer, Alexandre Mottrie, Alberto Breda, Andrea Minervini, Riccardo Campi, Andrea Salonia, Alberto Briganti, Francesco Montorsi, Umberto Capitanio, Alessandro Larcher
Institutions: Vita-Salute San Raffaele University, IRCCS Ospedale San Raffaele, Ospedale Papa Giovanni XXIII, Yonsei University, Yonsei University Health System, St.-Antonius-Hospital Gronau, Fox Chase Cancer Center, Swedish Medical Center, Guy's and St Thomas' NHS Foundation Trust, Icahn School of Medicine at Mount Sinai, KU Leuven, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, IRCCS Azienda Ospedliero-Universitaria di Bologna Policlinico di Sant'Orsola, University of Bologna, Université de Rennes, Chinese PLA General Hospital, Chinese People's Liberation Army, University of California San Diego, Onze Lieve Vrouwziekenhuis Hospital, Puigvert Foundation, Universitat de Barcelona, Azienda Ospedaliero-Universitaria Careggi, University of Florence
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W7123413948