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Updated: Jul 16, 2025
A Pre-Clinical Porcine Model of Orthotopic Heart Transplantation
Published on: April 27, 2019
Higher-risk SIPAT score predicts increased risk of long-term mortality in orthotopic heart transplant recipients
Revanth Kosaraju1, Elizabeth Vandenbogaart1, Erin Core1
1Department of Medicine, Division of Cardiology, University of California Los Angeles, Los Angeles, CA 90095, United States of America.
Insights
The Stanford Integrated Psychosocial Assessment for Transplant (SIPAT) identifies patients at higher risk for poor outcomes. Higher SIPAT scores predict reduced long-term survival after orthotopic heart transplantation (OHT).
Area of Science:
- Cardiology
- Transplantation Medicine
- Psychosocial Health
Background:
- Orthotopic heart transplantation (OHT) enhances survival for eligible patients.
- Organ scarcity mandates rigorous pre-transplant evaluations.
- The Stanford Integrated Psychosocial Assessment for Transplant (SIPAT) assesses psychosocial risk for short-term outcomes.
Purpose of the Study:
- To determine if the Stanford Integrated Psychosocial Assessment for Transplant (SIPAT) predicts long-term survival post-orthotopic heart transplantation (OHT).
Main Methods:
- A retrospective cohort study analyzed data from 51 OHT recipients.
- Patients were categorized into low-risk (Excellent/Good SIPAT) and higher-risk (Minimum Acceptable Criteria/High Risk SIPAT) groups.
- Outcomes were compared between the two SIPAT-defined groups.
Main Results:
- Higher-risk SIPAT patients exhibited significantly reduced 10-year survival post-OHT (6.7 vs 8.8 years; 55% vs 82% survival).
- Higher-risk patients were more likely to reside in areas with greater income inequality and have a prior psychiatric history.
- Medication adherence and post-transplant psychiatric illness showed non-significant trends toward poorer outcomes in higher-risk group.
Conclusions:
- Elevated SIPAT scores are predictive of diminished long-term survival following OHT.
- Targeted interventions are needed to enhance outcomes for higher-risk transplant candidates.
Background:
Orthotopic heart transplantation (OHT) improves survival in eligible patients. Organ scarcity necessitates extensive clinical and psychosocial evaluations before listing. The Stanford Integrated Psychosocial Assessment for Transplant (SIPAT) predicts risk for poor psychosocial outcomes and morbidity in the first year post-transplant, yet it is unknown whether it predicts long-term outcomes.
Methods:
Blinded examiners obtained data from a retrospective cohort of 51 OHT recipients from a high-volume center. Patients with "Excellent" or "Good" SIPAT score indicating low psychosocial risk for transplant (E/G) were compared with those who met "Minimum Acceptable Criteria" or were "High Risk" (MAC/HR). Associations were examined between SIPAT group and outcomes.
Results:
MAC/HR versus E/G recipients had significantly reduced survival in the 10 years post-OHT (mean 6.7 vs 8.8 years, p = 0.027; 55% vs 82% survival proportions, p = 0.037). MAC/HR patients were more likely to live in a county with greater income inequality (p = 0.025) and have psychiatric history pre-OHT (p = 0.046). Both groups had otherwise similar demographics and medical history. A lower proportion of MAC/HR patients adhered to medications post-OHT and a greater proportion had psychiatric illness, though differences were not significant.
Conclusions:
Higher-risk SIPAT scores predict reduced long-term survival post-OHT. Further efforts are crucial to improve outcomes in higher-risk patients.
