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

  • Nabil Ziad Melhem
  • Sarah Ledermann
  • Lesley Rees
Original Article



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.


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.


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.


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.


Twin-to-twin transfusion syndrome Chronic kidney disease Acute kidney injury Long-term outcome 


Compliance with ethical standards

The authors confirm that this was a retrospective analysis of case notes with no risk of harm to subjects and no inclusion of patient identifying information. Therefore, no consent from patients was indicated and ethical approval was not required.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© IPNA 2018

Authors and Affiliations

  1. 1.Department of Paediatric NephrologyGreat Ormond Street Hospital for Children NHS Foundation TrustLondonUK

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