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2017 ; 176
(9
): 1209-1215
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Renal function in neonates with twin-twin transfusion syndrome treated with or
without fetoscopic laser surgery
#MMPMID28730318
Verbeek L
; Joemmanbaks FA
; Quak JME
; Sukhai RN
; Middeldorp JM
; Oepkes D
; Lopriore E
Eur J Pediatr
2017[Sep]; 176
(9
): 1209-1215
PMID28730318
show ga
The aim of this study is to investigate the short-term renal function in neonates
with twin-twin transfusion syndrome (TTTS), treated with fetoscopic laser surgery
(laser group) or conservatively (non-laser group). Creatinine and urea levels and
urine output were recorded in the first week after birth. Primary outcome was
short-term renal dysfunction, defined as a creatinine level of >100 ?mol/L during
the first week postpartum. We evaluated 312 twins (laser group, n = 274;
non-laser group, n = 38). Median creatinine and urea levels were lower in the
laser group than in the non-laser group (71 versus 82 ?mol/L, p = 0.002).
Short-term renal dysfunction was lower in the laser group compared to the
non-laser group (7.2 versus 34.4%, p < 0.001). Within the laser group, creatinine
levels were significantly higher in the subgroup with incomplete laser surgery
compared to twins with successful laser surgery (76 versus 69 ?mol/L, p = 0.018).
No differences were found between donors and recipients except for a higher
incidence of oliguria in donors in the non-laser group on day 1. CONCLUSION:
Short-term renal dysfunction occurs less frequently in TTTS twins treated with
fetoscopic laser coagulation, particularly after complete surgery, suggesting
that laser surgery may have a protective effect on renal function. What is Known:
? Antenatally, donor twins in TTTS have severe oliguria due to chronic
hypovolemia and impaired renal perfusion ? Postnatally, donor twins may suffer
from severe renal complications, particularly in TTTS twins treated
conservatively. What is New: ? The incidence of short-term renal failure in TTTS
twins treated with complete laser surgery is low. ? After incomplete laser
surgery, the incidence of short-term renal dysfunction is increased.