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Published on: November 27, 2019
The Stanford Integrated Psychosocial Assessment for Transplantation: A Prospective Study of Medical and Psychosocial
José R Maldonado1, Yelizaveta Sher, Sermsak Lolak
1From the Department of Psychiatry & Behavioral Sciences (Maldonado, Neri, Sher, Skibola, Sullivan), Stanford University School of Medicine, Stanford, California; George Washington University School of Medicine and Health Science (Lolak), Washington, DC; Psychosomatic Medicine Research Laboratory (Swendsen), Stanford University, Stanford, California; Department of Social Services (David), Lucille Packard Children Hospital, Stanford, California; and Solid Organ Transplant Service Line (Standridge), Stanford Hospital and Clinics, Stanford, California.
Background:
Psychosocial factors may significantly affect post-transplant outcomes. The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) was developed as an assessment tool to enhance the pre-transplant psychosocial evaluation.
Methods:
We identified heart, lung, liver, or kidney transplant recipients assessed with the SIPAT pre-transplantation and transplanted between June 1, 2008, and July 31, 2011, at our institution. We analyzed prospectively accumulated psychosocial and medical outcomes at 1 year of follow-up.
Results:
217 patients were identified and included in the analysis. The primary outcomes of organ failure and mortality occurred in 12 and 21 patients, respectively, and were not significantly associated with the pre-transplant SIPAT scores. On the other hand, SIPAT scores were significantly correlated with the probability of poor medical and psychosocial outcomes (secondary outcomes). In fact, higher SIPAT scores predicted higher rates of rejection episodes (Spearman ρ = 0.15, 95% 95% confidence interval [CI] = 0.02-0.28, p = .023), medical hospitalizations (ρ = 0.29, 95% CI = 0.16-0.41, p < .001), infection rates (p = .020), psychiatric decompensation (p = .005), and support system failure (area under the curve = 0.70, 95% CI = 0.60-0.79, p < .001). The relationship with nonadherence suggested a trend, but no statistical significance was observed (area under the curve = 0.60, 95% CI = 0.50-0.71, p = .058).
Conclusions:
Study outcomes suggest that SIPAT is a promising pre-transplantation assessment tool that helps identify candidate's areas of psychosocial vulnerability and whose scores are associated with both psychosocial and medical outcomes after transplantation.
