Hepatic arterial buffer response: activation in donor fetuses and the effect of laser ablation of intertwin anastomosis

Jader de Jesus Cruz; Joana Bernardeco; Claudia Rijo; Alvaro Cohen; Fatima Serrano

doi:10.1515/jpm-2023-0191

Article

Hepatic arterial buffer response: activation in donor fetuses and the effect of laser ablation of intertwin anastomosis

Jader de Jesus Cruz , Joana Bernardeco , Claudia Rijo , Alvaro Cohen and Fatima Serrano

Published/Copyright: October 18, 2023

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From the journal Journal of Perinatal Medicine Volume 52 Issue 1

Abstract

Objectives

Hepatic arterial buffer response (HABR) is an important defence mechanism for maintaining liver blood flow. It is suspected that HABR is active in monochorionic diamniotic twins (MCDA) with twin-to-twin transfusion syndrome (TTTS) where donor compensates a setting of volume depletion and the recipient an overload. The present study investigates whether in TTTS, HABR is active in donor and/or recipient individually and try to determine if the activation of HABR is a direct response to TTTS.

Methods

Hepatic artery (HA) peak systolic velocity (PSV) was measured in normal MCDA fetuses and TTTS. Correlation with relevant fetal Dopplers and characteristics were determined. Z-scores for HA-PSV (HAV-Z) were calculated and its association with TTTS in donors and recipients were determined as well as changes in HAV-Z after laser treatment.

Results

In this study 118 MCDA were included, 61.9 % normal and 38.1 % TTTS. Of the TTTS 22 required laser treatment. A total of 382 scans were performed in normal group and 155 in TTTS. Our data demonstrates that in donors HAV-Z was 2.4 Z-scores higher compared to normal fetuses (β=2.429 95 % CI 1.887, 2.971; p<0.001) and after laser treatment HAV-Z reduced (β=−1.829 95 % CI −2.593, −1.064; p<0.001). There was no significant difference between recipients and normal (β=−0.092 95 % CI −0.633, 0.449; p=0.738).

Conclusions

HABR is active in TTTS, promoting an increased hepatic blood flow in donors. The activation is direct response to TTTS as shown by the reduction in HAV-Z after laser. This finding provides important insights into the pathophysiology of TTTS.

Keywords: monochorionic twin pregnancy; twin to twin transfusion syndrome; hepatic artery; fetal Doppler; fetal therapy; hepatic arterial buffer response

Corresponding author: Jader de Jesus Cruz, MD, MSc, Department of Fetal Medicine, Central Lisbon University Hospitals, R. Viriato 1, 2890-495, Lisbon, Portugal, E-mail: jaderjcruz@icloud.com

Research ethics: The research had complied with all relevant national regulations, institutional policies, and in accordance with tenets of the Helsinki Declaration, and has been approved by two Ethics Committee for Research under the numbers NMS/FCM-UNL nº08/2021/CEFCM and CHULC nº1008/2021.
Informed consent: Informed consent was obtained from all individuals included in this study, or their legal guardians or wards.
Author contributions: Each author listed made substantial contributions to the conception, design of the work; the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approved of the version to be published.
Competing interests: The authors state no conflict of interest of any form.
Research funding: None declared.
Data availability: The data that support the findings of this study are available from CHULC but restrictions apply to the availability of these data, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of CHULC.

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Received: 2023-05-05

Accepted: 2023-09-12

Published Online: 2023-10-18

Published in Print: 2024-01-29

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Articles in the same Issue

https://doi.org/10.1515/jpm-2023-0191

Keywords for this article

monochorionic twin pregnancy; twin to twin transfusion syndrome; hepatic artery; fetal Doppler; fetal therapy; hepatic arterial buffer response