A novel approach to off-clamp partial nephrectomy demonstrates significant improvements in renal injury in an experimental porcine model

  • Daniel Olvera-Posada Western University TEC Salud
  • Shouzhe Lin Western University
  • Ghaleb Aboalsamh Western University
  • Aaron Haig Western University
  • Ian Lobb Western University
  • Jaskirandeep Grewal Western University
  • Manujendra N. Saha Western University
  • Alp Sener Western University

Abstract

Introduction: We sought to design a partial nephrectomy (PN) with contralateral total nephrectomy porcine model and assess the underlying mechanisms of ischemia reperfusion injury (IRI) after PN using a novel, clinically approved resection device.

Methods: Domestic male pigs (n=9) underwent left lower pole PN, allocated to either standard (Group 1) or no ischemia PN (Group 2), followed by contralateral nephrectomy. Biochemical studies were performed at baseline, Day 2, and Day 7; after sacrifice, kidneys were processed for histological analysis. Apoptotic markers were measured by Western blot analyses. Urinary biomarkers were measured to assess acute kidney injury.

Results: At Day 2 following PN, there was a significant rise in serum creatinine in Group 1 compared to Group 2 (355 vs. 136 mmol/L; p=0.008). Intra-renal tissue oxygen saturation after PN was inversely correlated with postoperative creatinine (rs -0.75; p=0.012) and the grade of acute tubular necrosis (rs -0.70; p=0.036). We observed a rise in expression of pro-apoptotic markers and pro-inflammatory markers in Group 1 following PN compared to Group 2. Histological analysis revealed higher grade of apoptosis in Group 1.

Conclusions: IRI associated with standard PN has a deleterious impact on acute renal function, markers of tissue injury, and histological parameters, compared to off-clamp PN using the ALTRUS device. We identified several intraoperative and postoperative markers that may be used as predictors for functional and histological injury following PN.

Author Biography

Alp Sener, Western University
Assistant Professor of Surgery & Microbiology and Immunology
Director, Renal Transplant Fellowship Program
Schulich Clinician Scientist
Published
2017-10-12
How to Cite
Olvera-Posada, D., Lin, S., Aboalsamh, G., Haig, A., Lobb, I., Grewal, J., Saha, M. N., & Sener, A. (2017). A novel approach to off-clamp partial nephrectomy demonstrates significant improvements in renal injury in an experimental porcine model. Canadian Urological Association Journal, 11(10), E390-5. https://doi.org/10.5489/cuaj.4305
Section
Original Research