Application of the Clavien Classification of Surgical Complications to Robotic Kidney Transplantation

R. Garcia Roca, C. Martinez Parra, I. Tzvetanov, H. Jeon, E. Benedetti, J. Oberholzer.

Surgery, Transplant Division, University of Illinois Hospital and Health Sciences, Chicago, IL.

Meeting: 2015 American Transplant Congress

Abstract number: C228

Keywords: Kidney transplantation, Post-operative complications

Session Information

Session Name: Poster Session C: Surgical Issues/Ureteral Complications

Session Type: Poster Session

Date: Monday, May 4, 2015

Session Time: 5:30pm-6:30pm

Presentation Time: 5:30pm-6:30pm

Location: Exhibit Hall E

INTRODUCTION

The Clavien-Dindo Classification of complications after a surgical procedure is an objective measure of outcomes and serves as a comparison tool to evaluate procedure safety between surgeons or institutions. Additionally, the comprehensive complication index (CCI) considers multiple complications presenting in the same patient, assigning a score from 0 (no complication) to100 (death). Successful transplantation has other non-surgical factors that may compromise the outcomes unrelated to the actual intervention. We wanted to evaluate the applicability of the classification to renal transplantation by robotic approach.

METHODS

We retrospectively analyzed the 30-day complication rate after robotic kidney transplantation performed in 136 obese recipients from September 2009 to 2014. We classified the surgery complications using the Clavien-Dindo 2009 and calculated their CCI. Graft dysfunction requiring dialysis after surgery was classified as Grade IVA (single organ failure). Splenectomy after transplant for rescue of rejection was not considered a complication.

RESULTS

A total of 117 complications were recorded in 70 patients. Grade I complications (26.5%) were mostly related to wound seroma and due to dehydration. The most common complications were grade II (54.7%); rejection the main reason amongst them (20%) followed by urinary tract infections. Grade IIIA (4.3%) and IIIB (5.1%) were for treatment of collections (n=2) or urinary leak (n=6). Eight Grade IVA complications (6.8%) were observed, four were cardiovascular events and four due to graft dysfunction requiring dialysis. Finally, two deaths (grade V) occurred in the first month (1.7%). The mean CCI for the cohort is 14.4 (Table 1), we observed an increase in the mean CCI on the highest BMI group to 24.5 (p-value=0.1).

Mean CCI by BMI roups
BMI Group (kg/m2)	Complication (patients)	Mean CCI
30-39	33(25)	12.46
40-44	26(18)	13.86
45-49	31(15)	12.76
≥50	27(12)	24.52
Total	117(70)	14.45

CONCLUSIONS

The overall CCI of this cohort is low, indicating that the procedure should be considered safe. Treatment of rejection and graft dysfunction in need for dialysis may be expected after transplant and in our opinion should not be considered complications after the procedure. Further comparative studies are required.

To cite this abstract in AMA style:

Roca RGarcia, Parra CMartinez, Tzvetanov I, Jeon H, Benedetti E, Oberholzer J. Application of the Clavien Classification of Surgical Complications to Robotic Kidney Transplantation [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/application-of-the-clavien-classification-of-surgical-complications-to-robotic-kidney-transplantation/. Accessed November 21, 2024.

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