[Show abstract][Hide abstract] ABSTRACT: 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.
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.
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).
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.
Full-text · Article · Oct 2015 · Psychosomatic Medicine
[Show abstract][Hide abstract] ABSTRACT: With a limited number of available transplant organs, careful assessment of candidates is imperative. Medical criteria are well established for each end-organ system, but not psychosocial criteria. To address this, we developed a new assessment tool: Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) to assess psychosocial risk factors for organ transplantation. SIPAT has shown to have high inter-rater reliability (Pearson’s correlation coefficient = 0.853) and high predictability of psychosocial outcomes (P < 0.001).Methods and MaterialsHeart, lung, liver or kidney transplant candidates evaluated between 6/1/08-7/31/11 were assessed with SIPAT. We analyzed outcomes up to 1 year. Outcomes included: organ survival (primary); and patient survival, rejection, re-hospitalization, infection, non-compliance, psychiatric decompensation, failure of support, and albumin levels (secondary). Patients with SIPAT score of ≤ 20 were compared with patients with SIPAT score of ≥ 21.Results217 patients were transplanted in the index period (46 heart, 58 lung, 58 liver and 55 kidney). 181 of patients had SIPAT score of ≤ 20; 36 had scores of 21-68. There was no significant difference in primary outcome, however patients with higher SIPAT scores had significantly higher rates of psychiatric decompensation (p=0.006), non-adherence to treatment (p=0.027), and had a higher frequency of medical hospitalizations (p= 0.057). Moreover, patients with higher SIPAT scores who were hospitalized had more hospitalizations per person (2.23) than those with lower SIPAT scores (1.32). Planned, further surveillance of these patients may yield more significant results.Conclusions
The SIPAT is a comprehensive screening tool designed to predict psychosocial and medical outcomes of organ transplant candidates. Results suggest SIPAT is a promising tool to standardize the evaluation process and identify risk for negative outcomes to which interventions may be applied during selection.
Full-text · Article · Apr 2013 · The Journal of Heart and Lung Transplantation
[Show abstract][Hide abstract] ABSTRACT: While medical criteria have been well established for each end-organ system, psychosocial listing criteria are less standardized. To address this limitation, we developed and tested a new assessment tool: the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT).
The SIPAT was developed from a comprehensive review of the literature on the psychosocial factors that impact transplant outcomes. Five examiners blindly applied the SIPAT to 102 randomly selected transplant cases, including liver, heart, and lung patients. After all subject's files had been rated by the examiners, the respective transplant teams provided the research team with the patient's outcome data.
Univariate logistic regression models were fit in order to predict the transplant psychosocial outcome (positive or negative) using each rater's SIPAT scores. These results show that SIPAT scores are highly predictive of the transplant psychosocial outcome (P < 0.0001). The instrument has excellent inter-rater reliability (Pearson's correlation coefficient = 0.853), even among novice raters.
The SIPAT is a comprehensive screening tool to assist in the psychosocial assessment of organ transplant candidates. Its strengths includes the standardization of the evaluation process and its ability to identify subjects who are at risk for negative outcomes after the transplant, in order to allow for the development of interventions directed at improving the patient's candidacy. Our goal is that the SIPAT, in addition to a set of agreed upon minimal psychosocial listing criteria, would be used in combination with organ-specific medical listing criteria in order to establish standardized criteria for the selection of transplant recipients.