EXTRAUTERINE TWIN-TWIN TRANSFUSION AFFECTS RENAL-FUNCTION AND PERIOPERATIVE MANAGEMENT OF CONJOINED TWINS

This series describes the occurrence of unbalanced circulatory shuntin g in three consecutively treated pairs of conjoined twins. The impact of renal functional changes and compensatory cardiac physiology on the timing of surgery and perioperative management are illustrated. The c raniopagus set of twins presented in renal failure (1A) and cardiac fa ilure (1B) to our hospital at age 2.5 years. Renal transplantation for anuria was performed in 1A before separation of the twins, This did n ot improve urine output in the hypoperfused twin, and normal renal fun ction was not restored until the twins were separated. Two sets of omp halopagus twins were delivered and transferred to our hospital and sep arated during the first week of life. In each case a preoperative olig uric state in the underperfused twin reversed after separation, and a postoliguric diuresis ensued, Serum creatinine levels were similar in each pair preoperatively despite the inequality in urine volumes. In c onjoined twins, assessment of renal function is necessary and should i nclude serial measurements of urine volumes and urine creatinine clear ance. Serum creatinine is not a useful marker of individual twin renal function in this situation. When disparity in renal function exists, early separation is indicated to prevent renal failure and compensator y cardiac failure. Copyright (C) 1998 by W.B. Saunders Company.