Comparison of Clavien-Dindo classification and comprehensive complication index in patients undergoing simultaneous...

Detailed data on the relation of post-operative complications with clinical outcomes after simultaneous pancreas-kidney (SPK) transplantation is lacking.

To compare Clavien-Dindo classification (CDC) and comprehensive complication index (CCI) in predicting outcomes after SPK.

Data for patients undergoing SPK between 1999-2019 were analyzed. Information on recipients' baseline characteristics, peri-operative management and post-operative complications were collated. Length of hospital stay (LOS) was the primary study outcome, and the associations with CDC and CCI were evaluated using Spearman's (ρ) correlation coefficients.

In the study period, data were available for 128 patients (female n = 44, 34.4%). Sixty-nine patients had at least one complication with the highest CDC grade of I, II, III, and IV in 8 (6.3%), 22 (17.2%), 32 (25%), and 7 (5.5%) patients, respectively. The mean LOS was 21.4 ± 17.7 days. Both classification systems were correlated with LOS, yet CCI was stronger (Spearman's ρ: 0.694 vs 0.602, P < 0.001). Female patients (P = 0.019) and patients with pre-transplant cardiovascular events (P = 0.02) had longer LOS. After adjusted multivariable analysis, the link between LOS and both the CDC and CCI remained relevant. CCI had a superior fit compared to CDC (r ² = 0.729 vs r ² = 0.481), with every 10 CCI points being associated with a 5.27 day (P < 0.001) increased LOS.

This study showed that the CCI was better linked with LOS compared to CDC and might represent a useful score to evaluate the overall burden of postoperative complications in patients undergoing SPK.