Psychosocial Risk Factors and Outcomes Among Men and Women With Alcohol-Associated Liver Disease Undergoing...

Women with alcohol-associated liver disease (ALD) have been shown to be listed for transplant less frequently and have more psychiatric comorbidities as compared to men. This study aimed to analyze differences in psychosocial risk factors between men and women with ALD using the Stanford Integrated Psychosocial Assessment for Transplant (SIPAT), a pre-transplantation tool that assesses a candidate's psychosocial risk factors. The secondary aim was to determine if SIPAT scores are associated with transplant-related outcomes.

A single-center, retrospective cohort study was conducted. All outpatients with ALD who were evaluated for liver transplant between 2015 and 2021 and who had at least one completed SIPAT evaluation were included. Fisher's exact and Mann-Whitney U tests were used to compare baseline characteristics and SIPAT scores. Multivariable logistic regression was used to analyze transplant outcomes. Survival differences were assessed using survival analysis, with comparisons evaluated using the log-rank test.

Total SIPAT scores were similar between men and women, but women were found to have significantly higher psychopathology domain scores, related to higher rates of depression and anxiety. Higher psychopathology domain scores and presence of anxiety were associated with lower odds of death among women only. There were no differences in waitlisting, transplantation, or death between men and women with ALD.

This study highlights gender differences in psychosocial risk factors among patients with ALD undergoing transplant evaluation. The mechanism by which anxiety is associated with lower odds of death among women is unclear, and it remains to be seen whether this finding would be reproduced in a larger, prospective study or would generalize to women with other etiologies of cirrhosis. Overall, these findings underscore the importance of incorporating gender-sensitive, nuanced psychosocial assessment in the liver transplant evaluation process.