Utility of the Stanford Integrated Psychosocial Assessment for Transplant in predicting outcomes before and after lung transplantation

Abstract

Optimizing donor use and achieving maximal survival following lung transplantation (LTx) requires a pre-transplant assessment that identifies clinical, physiological and psychosocial patient factors associated with both poor and optimal post-LTx survival. We examined the utility of a psychosocial tool, the Stanford Integrated Psychosocial Assessment for Transplant (SIPAT) to identify patient suitability for LTx, as well as its association with clinical outcomes before and after LTx. Retrospective single center study analysing LTx assessment clinical variables (age, gender, diagnosis, functional capacity, nutrition, renal function), with a particular focus on the utility of the SIPAT score, to predict patient suitability for LTx. The same variables were analysed against LTx wait-list mortality, as well as post-LTx survival. Over an 8-yr period dating from December 2012, 914 patients (male 54.4%, mean age 55.2 yrs) underwent LTx assessment. Patients declined for LTx (n = 152, 16.6%) were older and had reduced functional capacity, nutritional markers and renal function, but had a higher SIPAT score. Once listed for LTx, a higher SIPAT score was not associated with wait-list mortality or reduced post-LTx survival. The SIPAT tool measures psychosocial suitability for transplantation that can be incorporated into a standardized assessment of LTx suitability. While patients with higher SIPAT score were more likely to be declined for LTx, the SIPAT score did not predict outcome in transplanted patients. A subgroup of patients with high SIPAT scores were successfully transplanted suggesting that unfavorable psychosocial variables are potentially modifiable with a well-resourced multidisciplinary LTx team.