Extrauterine twin-twin transfusion affects renal function and perioperative management of conjoined twins

David J. Klein, Robert M. Filler, Kenneth S. Azarow, Denis F. Geary

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


This series describes the occurrence of unbalanced circulatory shunting 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 craniopagus set of twins presented in renal failure (1A) and cardiac failure (1B) to our hospital at age 2.5 years. Renal transplantation for anuria was performed in 1A before separation of the twins. This did not improve urine output in the hypoperfused twin, and normal renal function was not restored until the twins were separated. Two sets of omphalopagus twins were delivered and transferred to our hospital and separated during the first week of life. In each case a preoperative oliguric 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 conjoined twins, assessment of renal function is necessary and should include serial measurements of urine volumes and urine creatinine clearance. 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 compensatory cardiac failure.

Original languageEnglish (US)
Pages (from-to)354-356
Number of pages3
JournalJournal of pediatric surgery
Issue number2
StatePublished - Feb 1998
Externally publishedYes


  • Conjoined twins
  • Renal function
  • Twin-twin transfusion

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health


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