Presentation Authors: Deepak Pruthi*, San Antonio, TX, Vivian Lu, Winnipeg, Canada, Jonathan Gelfond, San Antonio, TX, Ian Gibson, Winnipeg, Canada, Thomas McGregor, Kingston, Canada
Introduction: Patients undergoing radical nephrectomy are often counseled that it is safe to live with a solitary kidney as the renal transplant literature is often cited. We sought to determine if there were underlying histopathological differences in the non-neoplastic kidney (NNK) for patients undergoing radical nephrectomy (RN) for kidney cancer against matched patients undergoing donor nephrectomy (DN) for renal transplant.
Methods: Consecutive subjects who underwent either radical nephrectomy for kidney cancer or donor nephrectomy were included. Subjects underwent 1:1 matching with propensity score matching based on age, sex, pre-operative serum creatinine, hypertension, age-adjusted Charlson score, and BMI. Patients with diabetes, other pre-existing renal diseases, or prior kidney surgery were excluded. All slides were independently reviewed for histopathologic changes using the Banff 1997 criteria by two blinded nephropathologists. Differences in the NNK findings were assessed by Chi-square testing, Fischerâ€™s exact test, and the Mann-Whitney U test. Logistic regression was used to identify the covariates associated with NNK findings in the matched cohort.
Results: Of the 351 patients that met the inclusion criteria, 112 patients (56 per group) were matched. Patients who underwent RN were more likely to harbor glomerulopathy (p < 0.001) and arterial (odds ratio [OR] = 7.14; 95% confidence interval [CI] 2.7-20; p < 0.001) changes. Conversely, patients who underwent DN were more likely to have tubular atrophy (p < 0.001) and arteriolar changes (OR=6.76; 95% CI 2.52-20.54; p=0.002). There was no difference in the detection of interstitial fibrosis between the groups (p=0.90). The matched cohort logistic regression identified that increasing age was mildly significantly associated with increased risk of tubular atrophy (OR 1.11; 95% CI 1.05-1.18; p=0.001), interstitial fibrosis (OR=1.09; 95% CI 1.03-1.17; p=0.004), arterial (OR=1.11; 95% CI 1.05,1.18), and arteriolar changes (OR 1.07; 95% CI 1.02,1.14; p=0.007).
Conclusions: In a propensity-matched group patients undergoing radical nephrectomy for kidney cancer were more likely to harbor changes in the glomerular and arterial compartments while patients undergoing donor nephrectomy were more likely to have tubular atrophy and arteriolar changes. Investigation into these differences is warranted including the examination of downstream effects on renal function.