How a Donor Nephrectomy Population Can Help Give Perspective to the Effects of Renal Parenchymal Preservation during Partial Nephrectomy

Jim Shen, David Ruckle, Roger Li, Mohamed Keheila, Muhannad Alsyouf, Jared Schober, David Tryon, Phillip Stokes, Herbert C. Ruckle, Pedro Baron, Michael De Vera, D. Duane Baldwin

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Volume of renal parenchymal loss is known to affect postoperative renal function after partial nephrectomy (PN). We utilize a novel comparison using donor nephrectomy (DN) patients to demonstrate the primary effect parenchymal volume loss plays on postoperative renal function following PN. Materials and Methods: Records of 250 living donor (DN) and 118 PN patients were retrospectively reviewed. Baseline characteristics and preoperative estimated glomerular filtration rate (eGFR)s were recorded. Percent changes in eGFR and incidences of surgically induced chronic kidney disease (CKD-S) in short, intermediate, and long-term postoperative periods were compared. Univariate and multivariate analyses of prognostic factors for development of CKD-S were performed. The PN group was further divided into subgroups with different lengths of warm ischemia time (WIT) and compared with DN patients. Results: At baseline, DN patients were younger, less likely to be male, had lower body mass index, lower American Society of Anesthesiologists, and higher preoperative eGFR (all p < 0.001). At hospital discharge, intermediate follow-up, and latest follow-up, renal function changes in DN and PN groups were -40.5% vs. -3.6%, -34.1% vs. -5.5%, and -33.2% vs. -4.4%, respectively (all p < 0.001). More DN than PN patients developed CKD-S (p < 0.001). DN was a significant risk factor for the development of chronic kidney disease on univariate and multivariate analyses (p < 0.001). On subgroup analysis, both subgroups with WIT 1 to 30 minutes and 31 to 60 minutes had less renal function decline at all time points compared with DN (p < 0.001). Conclusions: Volume of renal parenchyma retained is the dominant driver of postoperative renal function after nephrectomy, compared with all other factors. Surgeons should minimize parenchymal loss during PN to optimize postoperative renal function.

Original languageEnglish (US)
Pages (from-to)417-422
Number of pages6
JournalJournal of Endourology
Issue number5
StatePublished - May 2019
Externally publishedYes


  • donor
  • glomerular filtration rate
  • nephrectomy
  • partial nephrectomy
  • warm ischemia

ASJC Scopus subject areas

  • Urology


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