Impact of ischaemia duration and clamping strategy in patients with solitary kidney undergoing partial nephrectomy.
Publication Title
BJU international
Document Type
Article
Publication Date
3-1-2026
Keywords
Humans; Nephrectomy; Male; Female; Middle Aged; Aged; Constriction; Kidney Neoplasms; Solitary Kidney; Glomerular Filtration Rate; Time Factors; Blood Loss, Surgical; Ischemia; Kidney; clamping strategies; functional outcomes; ischaemia time; kidney surgery; partial nephrectomy.; washington; swedish
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: On-clamp PN was performed in 56% of patients (n = 237). The median (interquartile range [IQR]) age, body mass index, preoperative estimated glomerular filtration rate (eGFR), clinical size and PADUA score were 65 (58-71) years, 27 (24-29) kg/m
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.
Area of Special Interest
Kidney & Diabetes
Specialty/Research Institute
Urology
Specialty/Research Institute
Nephrology
Specialty/Research Institute
Surgery
DOI
10.1111/bju.70146
