Parente A, Verhoeff K, Marfil-Garza BA, Sanchez-Fernandez N, Anderson BL, Bigam DL, Shapiro AJ, Dajani KZ. Comparison of Clavien–Dindo classification and comprehensive complication index in patients undergoing simultaneous pancreas-kidney transplantation. World J Transplant 2025; 15(4): 104399 [DOI: 10.5500/wjt.v15.i4.104399]
Corresponding Author of This Article
Alessandro Parente, MD, PhD, Department of Surgery, Division of Transplantation, University of Alberta Hospital, 8440 112 St NW, Edmonton T6G 2B7, Alberta, Canada. aleparen@gmail.com
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Transplantation
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Retrospective Study
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Dec 18, 2025 (publication date) through Nov 19, 2025
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World Journal of Transplantation
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2220-3230
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Parente A, Verhoeff K, Marfil-Garza BA, Sanchez-Fernandez N, Anderson BL, Bigam DL, Shapiro AJ, Dajani KZ. Comparison of Clavien–Dindo classification and comprehensive complication index in patients undergoing simultaneous pancreas-kidney transplantation. World J Transplant 2025; 15(4): 104399 [DOI: 10.5500/wjt.v15.i4.104399]
World J Transplant. Dec 18, 2025; 15(4): 104399 Published online Dec 18, 2025. doi: 10.5500/wjt.v15.i4.104399
Comparison of Clavien–Dindo classification and comprehensive complication index in patients undergoing simultaneous pancreas-kidney transplantation
Alessandro Parente, Kevin Verhoeff, Braulio A Marfil-Garza, Norberto Sanchez-Fernandez, Blaire L Anderson, David L Bigam, AM James Shapiro, Khaled Z Dajani
Alessandro Parente, Kevin Verhoeff, Braulio A Marfil-Garza, Norberto Sanchez-Fernandez, Blaire L Anderson, David L Bigam, AM James Shapiro, Khaled Z Dajani, Division of Transplantation, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta Hospital, Edmonton T6G 2B7, Alberta, Canada
Alessandro Parente, Kevin Verhoeff, Braulio A Marfil-Garza, AM James Shapiro, Alberta Diabetes Institute, University of Alberta Hospital, Edmonton T6G 2B7, Alberta, Canada
Braulio A Marfil-Garza, Tecnologico de Monterrey, The Institute for Obesity Research, Monterrey CP 64710, Mexico
Author contributions: Parente A, Verhoeff K and Dajani KZ wrote the manuscript, participated in the conception and design of the study and were involved in the acquisition, analysis, or interpretation of data; Parente A, Verhoeff K, Marfil-Garza BA, Sanchez-Fernandez N, Anderson BL, Bigam DL, Shapiro AMJ, and Dajani KZ critically reviewed and provided final approval of the manuscript; and all authors were responsible for the decision to submit the manuscript for publication.
Institutional review board statement: This study was approved by the Medical Ethics Committee of University of Alberta Hospital, approval No. Pro00087040.
Informed consent statement: This is a retrospective cohort study and informed consent of patients was not required as it involved the review of anonymized data.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The authors confirm that the data supporting the findings of this study are available within the article. Raw data that support the findings of this study are available from the corresponding author, upon reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Alessandro Parente, MD, PhD, Department of Surgery, Division of Transplantation, University of Alberta Hospital, 8440 112 St NW, Edmonton T6G 2B7, Alberta, Canada. aleparen@gmail.com
Received: December 19, 2024 Revised: March 23, 2025 Accepted: April 11, 2025 Published online: December 18, 2025 Processing time: 334 Days and 9.5 Hours
Abstract
BACKGROUND
Detailed data on the relation of post-operative complications with clinical outcomes after simultaneous pancreas-kidney (SPK) transplantation is lacking.
AIM
To compare Clavien-Dindo classification (CDC) and comprehensive complication index (CCI) in predicting outcomes after SPK.
METHODS
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.
RESULTS
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 (r2 = 0.729 vs r2 = 0.481), with every 10 CCI points being associated with a 5.27 day (P < 0.001) increased LOS.
CONCLUSION
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.
Core Tip: This is a retrospective single-center study to compare Clavien-Dindo classification and comprehensive complication index (CCI) in predicting outcomes after simultaneous pancreas-kidney transplantation. CCI has shown a stronger correlation with length of hospital stay when compared to Clavien-Dindo classification due to its cumulative nature. We advocate the utilization of CCI for future studies as it represents a more sensitive tool to better evaluate the overall burden of postoperative complications in patients undergoing simultaneous pancreas-kidney transplantation.
