The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT): A New Scale for the Prediction of Psychosocial and Medical Outcomes in Organ Transplant Candidates

Abstract

Purpose 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 Methods and Materials Heart, 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. Results 217 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.