ASSESSING THE IMPACT ON POSTOPERATIVE RENAL FUNCTION OF SELECTIVE EMBOLIZATION TO TREAT ARTERIAL BLEEDINGS AFTER PARTIAL NEPHRECTOMY: SINGLE CENTER ANALYSIS

INTRODUCTION AND OBJECTIVE: Selective arterial embolization (SAE) is an increasingly common therapeutic option for hemodynamically stable patients with post-partial nephrectomy (PN) haemorrhage. We investigated its impact on functional outcomes after nephron-sparing surgery. METHODS: our prospectively maintained database was searched for patients that required SAE to treat haemorrhage after PN, from January 2012 onwards. Their baseline characteristics and perioperative outcomes were collected and compared to those of a continuous series of individuals undergone PN with an uneventful postoperative course. The χ2 and Mann-Whitney tests were used for categorical and continuous variables, respectively. Logistic regression analyses assessed predictors of a significant renal function deterioration (sFRD), defined as ≧ 30% reduction of the estimated glomerular filtration rate (eGFR) at discharge. Kaplan Mayer (KM) analysis estimated the probabilities of developing, during follow-up, a worsening of the Chronic Kidney Disease (CKD) stage, compared to baseline values; the Log Rank test compared results in the two cohorts. RESULTS: Overall, 343 patients were included in the analysis: 12 in the SAE cohort and 331 in the control group. Patients’ and tumors’ characteristics were comparable at baseline (all p>0.07) (Table 1). The rate of postoperative sRFD was significantly higher among embolized patients (42% vs 6%; p<0.001) (Figure 1) and embolization was the only independent predictor of sRFD development (OR: 9.63; 95% CI: 2.75-33.7; p<0.001) (Table 2). KM analysis failed to identify any difference in the two cohorts concerning CKD progression at follow-up (Log Rank=0.13) (Figure 1). CONCLUSIONS: SAE has a significant impact on post-PN eGFR and remarkably increases the risk of sRFD but such a detrimental effect seems limited to the early postoperative period.