Measuring the Impact of Postsimultaneous Pancreas–Kidney Transplantation Complications: Comparing the Comprehensive Complication Index and Clavien–Dindo Classification

ABSTRACT Introduction The Clavien–Dindo classification (CDC) is commonly used for assessing postoperative complications; however, it may not be comprehensive. A comprehensive complication index (CCI) was introduced to address this limitation. This study aimed to compare the effectiveness of the CCI and CDC in evaluating the complications after simultaneous pancreas–kidney (SPK) transplantation. Methods Data were collected from patients who underwent SPK transplantation at our center between February 2018 and February 2021. Complications encountered during hospitalization were assessed using both the CDC and CCI. Linear regression analyses were performed to identify the factors related to postoperative length of stay (PLOS). Results Overall, 125 patients were included, with an average age of 46.87 years. Type 2 diabetes was present in 79% of the recipients. Among them, 117 patients experienced postoperative complications of CDC grades I (2.4%), II (57.6%), IIIa (8.0%), IIIb (9.6%), IVa (14.4%), IVb (0.8%), and V (0.8%) postoperative complications. The median CCI for the entire cohort was 37.2. Spearman's correlation analysis revealed significant associations between the CDC and PLOS and the CCI and PLOS. Notably, CCI exhibited a stronger correlation with PLOS (CCI: ρ = 0.698 vs. CDC: ρ = 0.524; p = 0.024). Conclusion The CCI demonstrated a stronger correlation with PLOS than CDC. Our finding suggests that the CCI may be a useful tool for comprehensively assessing complications following SPK transplantation.