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Pediatric Nephrology

Published in:

01-05-2019 | Original Article

Chronic kidney disease following twin-to-twin transfusion syndrome—long-term outcomes

Authors: Nabil Ziad Melhem, Sarah Ledermann, Lesley Rees

Published in: Pediatric Nephrology | Issue 5/2019

Abstract

Background

Amongst other sequelae, acute kidney injury (AKI) is a well-recognised post-natal complication of twin-to-twin transfusion syndrome (TTTS). Despite this, there has been a lack of data reporting long-term renal outcomes. Our aim was to report the long-term renal outcomes of infants born with TTTS.

Methods

We performed a retrospective case note review of all infants referred to our centre between 1998 and 2018 with a primary diagnosis of TTTS. Subjects with confirmed TTTS were divided into a chronic kidney disease (CKD) group and a non-CKD group for comparison.

Results

Twenty-six infants with TTTS were included for analysis. Eight (31%) subjects developed CKD. Within the CKD group, 50% went on to require long-term renal replacement therapy (RRT) of whom all underwent renal transplantation. For subjects who had neonatal AKI, cumulative survival rate before RRT at 5 and 10 years was 79% and 70%, respectively. Subjects with CKD had a significantly higher incidence of AKI in the neonatal period and were more likely to be the donor twin. Gestational age at birth, gender, antenatal interventions and comorbidities did not affect long-term renal outcome between the two groups.

Conclusion

This is the first long-term follow-up study demonstrating that CKD progressing to the need for RRT can develop after TTTS. Donor-twin status and neonatal AKI associated with adverse long-term outcomes warranting long-term surveillance in this group.

De Paepe ME, Luks FI (2013) What-and why-the pathologist should know about twin-to-twin transfusion syndrome. Pediatr Dev Pathol 16(4):237–251. https://doi.org/10.2350/13-03-1315-MISC.1 CrossRefPubMed

Habli M, Lim FY, Crombleholme T (2009) Twin-to-twin transfusion syndrome: a comprehensive update. Clin Perinatol 36(2):391–416, x. https://doi.org/10.1016/j.clp.2009.03.003 CrossRefPubMed

Mosquera C, Miller RS, Simpson LL (2012) Twin-twin transfusion syndrome. Semin Perinatol 36(3):182–189. https://doi.org/10.1053/j.semperi.2012.02.006 CrossRefPubMed

Beck M, Graf C, Ellenrieder B, Bokenkamp A, Huber A, Hecher K, Bartmann P (2005) Long-term outcome of kidney function after twin-twin transfusion syndrome treated by intrauterine laser coagulation. Pediatr Nephrol 20(11):1657–1659. https://doi.org/10.1007/s00467-005-1967-9 CrossRefPubMed

Ketteler M, Block GA, Evenepoel P, Fukagawa M, Herzog CA, McCann L, Moe SM, Shroff R, Tonelli MA, Toussaint ND, Vervloet MG, Leonard MB (2017) Executive summary of the 2017 KDIGO Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) Guideline Update: what’s changed and why it matters. Kidney Int 92(1):26–36. https://doi.org/10.1016/j.kint.2017.04.006 CrossRefPubMed

Selewski DT, Charlton JR, Jetton JG, Guillet R, Mhanna MJ, Askenazi DJ, Kent AL (2015) Neonatal acute kidney injury. Pediatrics 136(2):e463–e473. https://doi.org/10.1542/peds.2014-3819 CrossRefPubMed

Cincotta RB, Gray PH, Phythian G, Rogers YM, Chan FY (2000) Long term outcome of twin-twin transfusion syndrome. Arch Dis Child Fetal Neonatal Ed 83(3):F171–F176CrossRefPubMedPubMedCentral

Lenclen R, Paupe A, Ciarlo G, Couderc S, Castela F, Ortqvist L, Ville Y (2007) Neonatal outcome in preterm monochorionic twins with twin-to-twin transfusion syndrome after intrauterine treatment with amnioreduction or fetoscopic laser surgery: comparison with dichorionic twins. Am J Obstet Gynecol 196(5):450.e1-7. https://doi.org/10.1016/j.ajog.2007.01.036 CrossRefPubMed

Verbeek L, Joemmanbaks FA, Quak JME, Sukhai RN, Middeldorp JM, Oepkes D, Lopriore E (2017) Renal function in neonates with twin-twin transfusion syndrome treated with or without fetoscopic laser surgery. Eur J Pediatr 176(9):1209–1215. https://doi.org/10.1007/s00431-017-2964-2 CrossRefPubMedPubMedCentral

10.

Halvorsen CP, Ek S, Dellgren A, Grunewald C, Kublickas M, Westgren M, Norman M (2012) Survival and neonatal outcome after fetoscopic guided laser occlusion (FLOC) of twin-to-twin transfusion syndrome (TTTS) in Sweden. J Perinat Med 40(5):533–538. https://doi.org/10.1515/jpm-2011-0265 CrossRefPubMed

11.

Guilherme R, Patrier S, Gubler MC, Lemercier D, Guimiot F, Dommergues M (2009) Very early twin-to-twin transfusion syndrome and discordant activation of the renin-angiotensin system. Placenta 30(8):731–734. https://doi.org/10.1016/j.placenta.2009.06.001 CrossRefPubMed

12.

Shim SY, Cho SJ, Kong KA, Park EA (2017) Gestational age-specific sex difference in mortality and morbidities of preterm infants: a nationwide study. Sci Rep 7(1):6161. https://doi.org/10.1038/s41598-017-06490-8 CrossRefPubMedPubMedCentral

13.

Ville Y, Hyett J, Hecher K, Nicolaides K (1995) Preliminary experience with endoscopic laser surgery for severe twin-twin transfusion syndrome. N Engl J Med 332(4):224–227. https://doi.org/10.1056/NEJM199501263320404 CrossRefPubMed

14.

Maschke C, Diemert A, Hecher K, Bartmann P (2011) Long-term outcome after intrauterine laser treatment for twin-twin transfusion syndrome. Prenat Diagn 31(7):647–653. https://doi.org/10.1002/pd.2797 CrossRefPubMed

15.

Barr M Jr, Sedman AB, Heidelberger KP (1998) Renal tubular dysgenesis in twins. Pediatr Nephrol 12(5):408–413CrossRefPubMed

16.

De Paepe ME, Stopa E, Huang C, Hansen K, Luks FI (2003) Renal tubular apoptosis in twin-to-twin transfusion syndrome. Pediatr Dev Pathol 6(3):215–225. https://doi.org/10.1007/s10024-003-0109-2 CrossRefPubMed

17.

Oberg KC, Pestaner JP, Bielamowicz L, Hawkins EP (1999) Renal tubular dysgenesis in twin-twin transfusion syndrome. Pediatr Dev Pathol 2(1):25–32CrossRefPubMed

18.

Laube GF, Kemper MJ, Schubiger G, Neuhaus TJ (2007) Angiotensin-converting enzyme inhibitor fetopathy: long-term outcome. Arch Dis Child Fetal Neonatal Ed 92(5):F402–F403. https://doi.org/10.1136/adc.2006.101717 CrossRefPubMedPubMedCentral

19.

Pryde PG, Sedman AB, Nugent CE, Barr M Jr (1993) Angiotensin-converting enzyme inhibitor fetopathy. J Am Soc Nephrol 3(9):1575–1582PubMed

20.

Galea P, Barigye O, Wee L, Jain V, Sullivan M, Fisk NM (2008) The placenta contributes to activation of the renin angiotensin system in twin-twin transfusion syndrome. Placenta 29(8):734–742. https://doi.org/10.1016/j.placenta.2008.04.010 CrossRefPubMed

Title: Chronic kidney disease following twin-to-twin transfusion syndrome—long-term outcomes
Authors: Nabil Ziad Melhem
Sarah Ledermann
Lesley Rees
Publication date: 01-05-2019
Publisher: Springer Berlin Heidelberg
Published in: Pediatric Nephrology / Issue 5/2019
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI: https://doi.org/10.1007/s00467-018-4176-z

At a glance: The STEP trials

Springer Medicine

Chronic kidney disease following twin-to-twin transfusion syndrome—long-term outcomes

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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