The Stanford Integrated Psychosocial Assessment for Transplant Is Associated With Outcomes Before and After Liver Transplantation

Abstract [from journal]

Background: The Stanford Integrated Psychosocial Assessment for Transplant (SIPAT) is a standardized psychosocial evaluation tool used in liver transplant (LT) evaluation. Study aims were to assess the impact of the SIPAT score and sub-score domains on transplant waitlisting decisions and post-LT outcomes including immunosuppression (IS) non-adherence, biopsy-proven rejection, and mortality/graft failure.

Methods: We conducted a single center observational cohort study of 1430 patients evaluated for LT. Patients were divided in two groups based on a SIPAT cutoff of score < or ≥ 21 (higher SIPAT scores indicate higher psychosocial risk). Tacrolimus coefficient of variation (CoV) was used to measure IS non-adherence. Regression models assessed the relationship between total SIPAT score and domain scores and waitlisting decisions, IS non-adherence, allograft rejection, and patient death/graft failure.

Results: Patients with elevated total SIPAT and SIPAT domain scores were at higher risk of not being waitlisted for LT (total SIPAT ≥21 aOR=1.78, CI 1.36-2.33, readiness ≥5 aOR=2.01, CI 1.36-2.76, social support ≥4 aOR=1.50, CI 1.15-1.94, psychopathology ≥7 aOR=1.45, CI 1.07-1.94, and lifestyle/substance abuse ≥12 aOR=1.72, CI 1.23-2.39), and were more likely to experience IS non-adherence as measured by the tacrolimus CoV (total SIPAT ≥21 aOR=2.92, CI 1.69-5.03, readiness ≥5 aOR=3.26, CI 1.63-6.52, psychopathology ≥7 aOR=1.88, CI 1.00-3.50, and lifestyle substance abuse ≥ 12 aOR=3.03, CI 1.56-5.86). Patients with a SIPAT readiness score ≥5 were more likely to experience biopsy-proven allograft rejection (aOR=2.66, CI 1.20-5.91).

Conclusion: The SIPAT score was independently associated with LT listing decisions and IS non-adherence, and the readiness domain was associated with risk of allograft rejection. These findings offer insights into higher risk recipients that may require additional support prior to and after transplantation.