Renal function in neonates with twin-twin transfusion syndrome treated with or without fetoscopic laser surgery

Abstract

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 μmol/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 μmol/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 μmol/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.