title: The impact of ischemia on long-term renal function after partial nephrectomy in the two kidney model.
abstract: OBJECTIVE
  To determine whether on-clamp partial nephrectomy (ON-PN) has any significant impact on long-term renal function in a two kidney model.
  
  
  METHODS
  From November 1999 to July 2013, 607 patients underwent PN at our institution. After excluding patients with solitary kidneys, multiple renal masses, and follow-up less than 90 days, 331 remained. Patient demographics were assessed, as was renal function based on pre- and postoperative mercaptoacetyltriglycine (MAG-3) renal scans and change in estimated glomerular filtration rate (eGFR) using the preoperative and most recent recorded creatinine levels.
  
  
  RESULTS
  There were a total of 236 patients who underwent ON-PN and 95 who underwent off-clamp PN (OFF-PN) during the study period. The longest follow-up was 12.6 years with mean follow-up of 3 years. Mean ischemia time of patients undergoing ON-PN was 25 minutes (range 8-63 min). No differences were noted between the ON-PN and OFF-PN cohorts with respect to estimated change in eGFR (ON-PN: -6.07 mL/min/1.73 m(2) vs OFF-PN: -6.00 mL/min/1.73 m(2), P=0.69). No differences were noted in the % change in the MAG-3 renal scans (ON-PN: -0.77% vs OFF-PN: -1.1%, P=0.94). A post hoc sensitivity analysis of the same two variables stratified by age revealed no differences in change in estimated GFR or % change in differential function on renal scan.
  
  
  CONCLUSIONS
  In the two kidney model, ischemia does not appear to affect long-term renal function outcomes after PN. These data provide evidence that ON-PN is perfectly acceptable in the appropriately selected patient with two kidneys.
authors.affiliation: Department of Urology, Mayo Clinic Hospital , Phoenix, Arizona.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Salevitz
authors.forename: Michael W
authors.initials: MW
authors.lastname: Patton
authors.forename: Mark D
authors.initials: MD
authors.lastname: Tyson
authors.forename: Rafael
authors.initials: R
authors.lastname: Nunez-Nateras
authors.forename: Erin N
authors.initials: EN
authors.lastname: Ferrigni
authors.forename: Paul E
authors.initials: PE
authors.lastname: Andrews
authors.forename: Mitchell R
authors.initials: MR
authors.lastname: Humphreys
authors.forename: Erik P
authors.initials: EP
authors.lastname: Castle
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000601:surgery*; D003250:Constriction; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000098:blood supply* / Q000503:physiopathology; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D012189:Retrospective Studies; D052096:Warm Ischemia