We identified 234 patients who underwent PKA at two large academic institutions in the US. Trifecta was defined as absence of perioperative complications, no significant eGFR reduction (>25% reduction from baseline eGFR), and no evidence of disease (recurrence, metastasis, survival). The incidence of significant eGFR reduction and recurrence was estimated using the Kaplan-Meier method. Univariate and multivariate analysis were used to identify predictors of Trifecta achievement.RESULTS: Preoperative characteristics of the study population are shown in table 1. Tumor stage was T1a in 216 (92.3%) and T1b in 18 (7.7%). Median follow-up was 42.4 months. Trifecta was achieved in 142 patients (60.7%). Overall 59 patients (25.2%) developed significant eGFR reduction and 28 patients (12.0%) developed recurrence that was managed successfully with repeat ablation in 11 patients and subsequent surgery in 14 patients. 3 patients did not undergo additional treatment. Complications occurred in 21 patients (9%). The most frequent complications were small subcapsular hematomas and hematuria. Only one patient required embolization for right intra-lobar artery hemorrhage. At univariate analysis, gender (OR 0.30), race (OR 0.58), baseline eGFR (OR 0.99), tumor size (OR 0.65) and tumor stage (OR 0.29) emerged as predictors of trifecta achievement. Gender, baseline eGFR and tumor size also remained significant at the multivariable analysis.CONCLUSIONS: Our findings confirm that PKA represents a safe and effective treatment option in patients with renal mass. Tumor size, baseline eGFR and gender seem to be strong predictors of Trifecta outcomes, and they should be considered when determining treatment plan.