Comparison of Donor and Recipient Outcomes Following Laser Therapy Performed for Twin–Twin Transfusion Syndrome: A Meta-Analysis and Review of Literature

Abstract

We reviewed current literature about donor and recipient outcomes after laser therapy performed for twin-twin transfusion syndrome (TTTS). Study inclusion criteria were monochorionic diamniotic pregnancies, TTTS diagnosed with standard criteria, survival, and cerebral anomalies rates defined individually for donors and recipients. Exclusion criteria were studies including triplets and monoamniotic pregnancies, therapeutic techniques different from laser therapy, data reported in graphs or percentage, and non-English language publications. Meta-analysis was performed by random effects model whenever heterogeneity across studies was > 25%. Fifteen articles were reviewed. Survival rate was 60% in donors and 70% in recipients ( P = 0.0002; odds ratio: 0.66; 95% confidence interval: 0.53 to 0.82). Neurological morbidity did not differ between twins (donors: 9% versus recipients: 10%; P = 0.66). This review shows that recipients are more likely to survive as compared with donors, whereas no differences are noted with regard to neurological morbidity. It may be hypothesized that a lethal injury (to which donors appear to be more sensitive) or a cerebral damage (with which donors and recipients are equally affected) occurs before the timing of surgery. Therefore, a study protocol to assess whether diagnosis of TTTS may be anticipated in the first trimester is proposed.