Twin-to-twin transfusion syndrome and neonatal acute kidney injury after selective fetoscopic laser photocoagulation.

BACKGROUND

Selective Fetoscopic Laser Photocoagulation (SFLP) is used to treat Twin-Twin Transfusion Syndrome (TTTS), affecting 10-15% of monochorionic twin pregnancies. Historical data have reported neonatal acute kidney injury (AKI) as high as 50% following TTTS; however, the incidence of AKI following SFLP remains poorly characterized.

METHODS

We conducted a single-center retrospective study of monochorionic diamniotic twins who underwent SFLP for TTTS between 2010 and 2023. The primary outcome was the development of AKI during the first two weeks of life, defined by the Neonatal Modified KDIGO criteria. Mixed-effects logistic regression was performed to identify associations with AKI.

RESULTS

Among 103 infants included, 15 (14.6%) developed AKI. Twins with AKI were born at earlier gestational age (26 weeks vs. 30 weeks, p < 0.001) and had lower birth weights (923 vs. 1320 g, p = 0.01). Adjusted analysis demonstrated longer latency to delivery (OR 0.69, 95% CI 0.54-0.88) and greater total number of arteriovenous (AV) anastomoses (OR 0.78, 95% CI 0.64-0.94) were associated with decreased odds of AKI.

CONCLUSION

Our postnatal incidence of AKI following SFLP for TTTS is less common than previously described. Our findings suggest that a more extensive AV anastomotic network and/or longer latency to delivery may allow for improved hemodynamic balance and kidney maturation.