title: Comparative Effects of Irreversible Electroporation, Radiofrequency Ablation, and Partial Nephrectomy on Renal Function Preservation in a Porcine Solitary Kidney Model.
abstract: OBJECTIVE
  To evaluate kidney function preservation or regeneration and pathological changes post-irreversible electroporation (IRE) in comparison with partial nephrectomy and radiofrequency ablation (RFA) in a solitary kidney porcine model. Tissue ablation using IRE has been reported to spare critical anatomic structures within or near the ablation zone with associated regeneration of adjacent parenchyma, possibly offering functional preservation.
  
  
  METHODS
  Fifteen pigs initially underwent laparoscopic nephrectomy. The lower third of the remaining kidney was then ablated or removed with either IRE, RFA, or partial nephrectomy. Serum creatinine (SCr) was measured at baseline, 24 hours, 3, 7, 14, and 28 days postoperatively. The impact of the type of procedure on SCr over time was evaluated. Acute and chronic histological changes were analyzed and cellular viability was assessed using nicotinamide adenine dinucleotide staining in the IRE ablations.
  
  
  RESULTS
  Ten ablations (5 IRE, 5 RFA) and 5 partial nephrectomies of the entire lower third of a solitary kidney were performed. The type of procedure did not affect SCr significantly at baseline (P = .14) or change in SCr over time (P = .48). Histologically, IRE and RFA lesions showed similar findings including coagulative necrosis that progressively was replaced by reparative stromal changes and fibrous tissue. Nicotinamide adenine dinucleotide staining of the IRE lesions at 14 and 28 days showed no viability in the necrotic areas with viable tissue at the margins demonstrating reparative changes.
  
  
  CONCLUSIONS
  Large volume IRE ablation of normal renal parenchyma in the porcine model does not provide a functional advantage as compared with conventional renal tumor treatments.
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Monica S C
authors.initials: MS
authors.lastname: Morgan
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Asim
authors.initials: A
authors.lastname: Ozayar
authors.affiliation: Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Elena
authors.initials: E
authors.lastname: Lucas
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Justin I
authors.initials: JI
authors.lastname: Friedlander
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Nabeel A
authors.initials: NA
authors.lastname: Shakir
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX. Electronic address: jeffrey.cadeddu@utsouthwestern.edu.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Cadeddu
mesh_terms: D000818:Animals; D017115:Catheter Ablation; D004195:Disease Models, Animal; D018274:Electroporation; D005260:Female; D007668:Kidney / Q000002:abnormalities* / Q000503:physiopathology / Q000601:surgery; D007677:Kidney Function Tests; D009392:Nephrectomy / Q000379:methods*; D013552:Swine; D014564:Urogenital Abnormalities / Q000503:physiopathology* / Q000601:surgery*