title: Impact of ischaemia time on renal function after partial nephrectomy: a systematic review.
abstract: OBJECTIVE
  To assess the impact of ischaemia on renal function after partial nephrectomy (PN).
  
  
  METHODS
  A literature review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. In January 2015, the Medline and Embase databases were systematically searched using the protocol ('warm ischemia'[mesh] OR 'warm ischemia'[ti]) AND ('nephrectomy'[mesh] OR 'partial nephrectomy'[ti]). An updated search was performed in December 2015. Only studies based on a solitary kidney model or on a two-kidney model but with assessment of split renal function were included in this review.
  
  
  RESULTS
  Of the 1119 studies identified, 969 abstracts were screened after duplicates were removed: 29 articles were finally included in this review, including nine studies that focused on patients with a solitary kidney. None of the nine studies adjusting for the amount of preserved parenchyma found a negative impact of warm ischaemia time on postoperative renal function, unless this was extended beyond a 25-min threshold. The quality and the quantity of preserved parenchyma appeared to be the main contributors to postoperative renal function.
  
  
  CONCLUSIONS
  Currently, no evidence supports that limited ischaemia time (i.e. ≤25 min) has a higher risk of reducing renal function after PN compared to a 'zero ischaemia' technique. Several recent studies have suggested that prolonged warm ischaemia (>25-30 min) could cause an irreversible ischaemic insult to the surgically treated kidney.
authors.affiliation: AP-HP, Service d'Urologie, Hopital de la Pitié Salpétrière, Paris, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Rod
authors.affiliation: Service d'Urologie, Hopital Pontchaillou, Rennes, France.
authors.forename: Benoit
authors.initials: B
authors.lastname: Peyronnet
authors.affiliation: AP-HP, Service d'Urologie, Hopital de la Pitié Salpétrière, Paris, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Seisen
authors.affiliation: Service d'Urologie, Hopital Bretonneau, Tours, France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Pradere
authors.affiliation: Service d'Urologie, CHU Liège, Liège, Belgium.
authors.forename: Florie D
authors.initials: FD
authors.lastname: Gomez
authors.affiliation: Service d'Urologie, Hopital Pontchaillou, Rennes, France.
authors.forename: Grégory
authors.initials: G
authors.lastname: Verhoest
authors.affiliation: AP-HP, Service d'Urologie, Hopital de la Pitié Salpétrière, Paris, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Vaessen
authors.affiliation: Service d'Urologie, Hopital Mondor, Créteil, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: De La Taille
authors.affiliation: Service d'Urologie, Hopital Pontchaillou, Rennes, France.
authors.forename: Karim
authors.initials: K
authors.lastname: Bensalah
authors.affiliation: AP-HP, Service d'Urologie, Hopital de la Pitié Salpétrière, Paris, France. mroupret@gmail.com.|Université PARIS VI Pierre et Marie Curie, Paris, France. mroupret@gmail.com.
authors.forename: Morgan
authors.initials: M
authors.lastname: Roupret
mesh_terms: D006801:Humans; D007668:Kidney / Q000098:blood supply*; D007680:Kidney Neoplasms / Q000601:surgery*; D009392:Nephrectomy / Q000379:methods*; D013997:Time Factors; D052096:Warm Ischemia / Q000379:methods*
keywords: ischaemia; kidney neoplasm; partial nephrectomy; renal function