Stanford Integrated Psychosocial Assessment For Transplantation Research Articles

A semi-structured interview is associated with bariatric surgery outcomes.

Pre-surgical psychological evaluations (PSPE) are required by many insurance companies and used to help identify risk factors that may compromise bariatric post-surgical outcomes. These evaluations, however, are not yet standardized. The present study investigated the utility of a semi-structured assessment, Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT), on post-surgical outcomes across 18 months. A total of 272 adult patients underwent a psychosocial evaluation and received bariatric surgery November 2017 to September 2020 at a Midwestern academic medical center. Average age at pre-surgical evaluation was 45.2 (SD = 10.7) years and 82.3% of patients were female (n = 224). With an a priori α of 0.05, multi-level modeling with weight as the outcome and regression with complications as the outcome were used. Higher SIPAT Patient Readiness, indicating difficulty with adhering to health behaviors and a reduced understanding of bariatric surgery, was associated with elevated patient weight at the 18-month follow-up (𝛽 = 0.129, p = 0.03). Higher SIPAT Social Support, was associated with patient weight at the 18-month follow-up, with reduced support associated with greater weight (𝛽 = 0.254, p = 0.004). Higher SIPAT Social Support also was associated with a greater risk of complications across the 18-month follow-up window (𝛽 = -0.108, p = 0.05). Patients with higher readiness to adhere to behavioral changes, and those reporting an intact social support system, generally weighed less at 18 months. The SIPAT may be considered as part of the standardized pre-surgical assessment, however, further research is required to elucidate its utility.

Alcoholic aetiology and severity of liver disease is correlated with worse Stanford Integrated Psychosocial Assessment for Transplant (SIPAT) in liver transplant candidates (LT) and correlates with post-transplant adherence

Alcoholic aetiology and severity of liver disease is correlated with worse Stanford Integrated Psychosocial Assessment for Transplant (SIPAT) in liver transplant candidates (LT) and correlates with post-transplant adherence

Assessing the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) in Risk-Stratifying Multiple Myeloma Patients for Autologous Stem Cell Transplantation

Background: Hematopoietic stem cell transplant (SCT) is a high-intensity treatment that can cause psychological distress. Pre-transplant psychosocial screening is commonly used to assess mental health, social support, compliance, and health behaviors in HCT centers. However, the optimal standardized approach to psychosocial screening is still being defined. Some studies have shown that pre-transplant psychosocial assessments can predict overall survival (OS) after SCT, while others have found associations with non-relapse mortality (NRM) but not with OS. Single-institution reports consistently indicate that pre-HCT psychosocial assessments are associated with the length of SCT hospitalization and readmission rate. The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) is an established tool in the solid organ transplant field that can be used to assess and quantify psychosocial risk, that can help in patient selection and pre-transplant preparation. Objective: This study aimed to validate the SIPAT as a standardized psychological assessment in patients with multiple myeloma (MM) undergoing autologous SCT (ASCT). The primary goal was to analyze the impact of psychosocial risk, as measured by the SIPAT score, on the length of hospital stay and readmission rates within 100 days post-discharge. Secondary outcomes included the risk of infections, progression-free survival (PFS), and overall survival (OS). Methods: This retrospective, single-center study included 87 patients with MM who underwent ASCT between 2019 and 2022 at University Hospitals Seidman Cancer Center. Patient and disease characteristics were collected, and SIPAT scores were recorded for all patients. Patients were grouped based on their SIPAT scores as “Excellent” (score ≤ 6) or “Good” (score > 6). Hospitalization duration during transplant, readmissions, and infections within the first 100 days after ASCT were used as indicators of treatment-related toxicity. Results: 30 patients had an “Excellent” SIPAT score (mean score: 3.47, SD 1.81), while 57 had a “Good” score (mean score: 11.81, SD 5.92). Both groups exhibited similar sex and race distribution, BMI, and KPS scores. The “Excellent” SIPAT group had more patients with HCT-CI scores of 0-2. Both groups had comparable ISS staging and high-risk cytogenetics, along with similar prior lines of treatment and disease status at the time of transplant. Patients in the “Good” SIPAT score group had a higher number of CD34+ cells infused per kg. No significant differences were observed between the groups in terms of engraftment time, hospitalization duration, or rates of hospitalizations and infections within the first 100 days after transplant. Univariate analysis of risk of readmissions showed that BMI had a significant effect (HR 1.09, 95% CI 1.02-1.16, p=0.009) for each unit increase and HCT-CI had a significant effect (HR 5.56, 95% CI 1.39-22.24, p=0.015) for HCT-CI score 3+ compared to 0-2. However, in the multivariable model, these effects did not persist. Conclusions: Although the SIPAT tool is widely used for evaluating different organ transplants, including HCT, a high SIPAT score alone may not be sufficient to risk-stratify candidates for ASCT in MM. Further research and evaluation are warranted to better understand the true predictive value of pre-transplant psychosocial assessments.

Assessing reliability and validity of SIPAT and opportunities for improvement: A single-center cohort study.

Psychosocial assessment is a standard component of patient evaluations for transplant candidacy. The Stanford Integrated Psychosocial Assessment for Transplant (SIPAT) is a widely used measure to assess psychosocial risk for transplant. However, there are questions regarding the SIPAT's reliability and validity. We examined the SIPAT's psychometric performance and its impact on equitable access to transplant in a diverse cohort of 2825 patients seeking liver transplantation between 2014 and 2021 at an urban transplant center. The SIPAT demonstrated good internal consistency reliability at the overall score [Cronbach's α = 0.85, 95% CI (0.83, 0.86)] and domain levels (0.80 > α > 0.70). There was mixed support for structural validity, with poor overall model fit in confirmatory factor analysis and 50% of questions achieving the 0.70-factor loadings threshold. Adjusting for sociodemographic variables, the odds of not being waitlisted for psychosocial reasons were three times higher for patients with Medicaid insurance than patients with private insurance [OR 3.24, 95% CI (2.09, 4.99)] or Medicare [OR 2.89, 95% CI (1.84, 4.53)], mediated by higher SIPAT scores. Black patients had nearly twice the odds of White patients [OR 1.88, 95% CI (1.20, 2.91)], partially mediated by higher social support domain scores. Patients with Medicaid, non-White patients, and those without a college degree scored significantly higher on collinear questions, disproportionately contributing to higher SIPAT scores. The SIPAT did not perform equally across insurance type, race/ethnicity, and education groups, with the lowest subgroup validity associated with patient readiness and psychopathology domains. The SIPAT should be interpreted with caution, especially as a composite score. Future studies should examine validity in other populations.

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

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.

(201) Clinical and Epidemiological Characterization of Candidates to Heart Transplantation Using the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT)

(201) Clinical and Epidemiological Characterization of Candidates to Heart Transplantation Using the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT)

Alcohol Use in Liver Transplant Recipients With Alcohol-related Liver Disease: A Comparative Assessment of Relapse Prediction Models.

The selection of liver transplant (LT) candidates with alcohol-related liver disease (ALD) is influenced by the risk of alcohol relapse (AR), yet the ability to predict AR is limited. We evaluate psychosocial factors associated with post-LT AR and compare the performance of high-risk alcoholism risk (HRAR), sustained alcohol use post-LT (SALT), and the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) scores in predicting relapse. A retrospective analysis of ALD patients undergoing LT from 2015 to 2021 at a single US transplant center was performed. Risk factors associated with post-LT AR were evaluated and test characteristics of 3 prediction models were compared. Of 219 ALD LT recipients, 23 (11%) had AR during a median study follow-up of 37.5 mo. On multivariate analysis, comorbid psychiatric illness (odds ratio 5.22) and continued alcohol use after advice from a health care provider (odds ratio 3.8) were found to be significantly associated with post-LT AR. On sensitivity analysis, SIPAT of 30 was optimal on discriminating between ALD LT recipients with and without post-LT AR. SIPAT outperformed both the HRAR and SALT scores (c-statistic 0.67 versus 0.59 and 0.62, respectively) in identifying post-LT AR. However, all scores had poor positive predictive value (<25%). AR after LT is associated with comorbid psychiatric illness and lack of heeding health care provider advice to abstain from alcohol. Although SIPAT outperformed the HRAR and SALT scores in predicting AR, all are poor predictors. The current tools to predict post-LT AR should not be used to exclude LT candidacy.

Higher-risk SIPAT score predicts increased risk of long-term mortality in orthotopic heart transplant recipients

BackgroundOrthotopic 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. MethodsBlinded 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. ResultsMAC/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. ConclusionsHigher-risk SIPAT scores predict reduced long-term survival post-OHT. Further efforts are crucial to improve outcomes in higher-risk patients.

Characterization of the stanford integrated psychosocial assessment for transplant for heart, liver, and kidney transplant candidates in Japan

BackgroundThe Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) is a comprehensive psychosocial assessment proven useful for predicting the outcomes of organ transplantation that is expected to be useful in Japan. However, the characteristics of organ-specific SIPAT scores for organ transplant recipient candidates in Japan are unclear and, to date, the SIPAT has not been properly utilized in clinical practice. The purpose of this study was to present basic data that can be used to establish the relation between SIPAT scores and post-transplantation psychosocial outcomes as well as organ-specific outcomes.MethodsThis study included 167 transplant recipient candidates (25 heart, 71 liver, and 71 kidney) who completed a semi-structured interview based on the Japanese version of SIPAT (SIPAT-J) prior to transplantation. The differences between organs in terms of SIPAT scores and differences in SIPAT scores based on demographic data were comparatively analyzed.ResultsThe total SIPAT scores were higher for liver recipient candidates than for heart recipient candidates (P = .019). Regarding the subscales, SIPAT B (social support system) scores were higher for liver and kidney recipient candidates than for heart recipient candidates (P = .021), whereas SIPAT C (psychological stability and psychopathology) scores were higher for liver recipient candidates than for kidney recipient candidates (P = .002). Recipient candidates with a history of psychiatric treatment and those who were unemployed had higher SIPAT scores, regardless of the transplant organ, than recipient candidates without a history of psychiatric treatment and those who were employed (P < .001, P = .016, respectively).ConclusionsThere were notable differences in the total SIPAT-J and subscale scores among the liver, heart, and kidney recipient candidates. Each organ was associated with specific psychosocial issues that should be addressed before transplantation. Interventions such as information provision and patient education based on SIPAT assessment results for each organ may improve recipient post-transplant outcomes.

Associations between the stanford integrated psychosocial assessment for transplant and one-year lung transplant medical and psychosocial outcomes.

The Stanford Integrated Psychosocial Assessment for Transplant (SIPAT) is a standardized measure of the psychosocial risk profile of solid organ transplant candidates. While studies have found associations between this measure and transplant outcomes, to date this has not been examined in lung transplant recipients. We examined relations between pre-transplant SIPAT scores and 1-year lung transplant medical and psychosocial outcomes in a sample of 45 lung transplant recipients. The SIPAT was significantly associated with 6-minute walk test (χ2(1) = 6.47, p = .010), number of readmissions (χ2(1) = 6.47, p = .011), and mental health services utilization (χ2(1) = 18.15, p < .001). It was not a significantly associated with the presence of organ rejection or mortality (ps > 0.10). Results suggest that the SIPAT can help identify patients who are at an elevated risk for transplant complications and thus would benefit from services to mitigate risk factors and improve outcomes.

Psychosocial assessment in liver transplantation (LT): an analysis of short-term outcomes.

Our research showed that patients with alcohol-associated liver disease (ALD) had more severe liver disease than those without a diagnosis of ALD yet were less likely to be selected for transplant listing due to their increased psychosocial vulnerability. This study aims to answer whether this vulnerability translates to worse short-term outcomes after transplant listing. A total of 187 patients were approved for liver transplant listing and are included in the present retrospective study. We collected dates of transplantation, retransplantation, death, and pathologic data for evidence of rejection, and reviewed alcohol biomarkers and documentation for evidence of alcohol use. The ALD cohort had higher Stanford Integrated Psychosocial Assessment for Transplant (SIPAT) scores (39.4 vs. 22.5, p <0.001) and Model for End-Stage Liver Disease (MELD)-Na scores (25.0 vs. 18.5, p <0.001) compared with the non-ALD cohort. Forty-nine (59.7%) subjects with ALD and 60 (57.1%, p =0.71) subjects without ALD subsequently received a liver transplant. Overall mortality was similar between the 2 groups (20.7% ALD vs. 21.0% non-ALD, p =0.97). Neither the SIPAT score (HR: 0.98, 95% CI: 0.96-1.00, p =0.11) nor MELD-Na score (HR 0.99, 95% CI 0.95-1.02, p =0.40) were associated with mortality. Patients with ALD were more likely to have alcohol biomarkers tested both before (84.1% vs. 24.8% non-ALD, p <0.001) and after liver transplantation (74.0% vs. 16.7% non-ALD, p <0.001). SIPAT score was associated with alcohol use after listing (OR: 1.03, 95% CI: 1.0-1.07, p =0.04), although a return to alcohol use was not associated with mortality (HR: 1.60, 95% CI: 0.63-4.10, p =0.33). Patients with ALD had higher psychosocial risk compared with patients without a diagnosis of ALD who were placed on the waitlist, but had similar short-term outcomes including mortality, transplantation, and rejection. Although a high SIPAT score was predictive of alcohol use, in the short-term, alcohol use after transplant listing was not associated with mortality.

Psychosocial Risk Differences Among Veteran Organ Transplant Groups: Rehabilitation Targets to Promote Transplant Listing Outcomes

Research Objectives To investigate differences in psychosocial risk profiles among Veteran transplant groups during mental health (MH) pre-transplant evaluations to inform rehabilitation targets to promote transplant listing and general outcomes. Design Cross-sectional study. Setting VA Hospital. Participants 76 male Veterans ranging in age from 29–86 (M=62.9, SD=8.8) undergoing kidney (n=29), liver (n=31), or stem cell (SCT; n=16) transplantation work-up. Sixty-two percent identified as white, 30% Black, 5% Latinx, and 1% American Indian/Alaska Native (1% declined to answer). Interventions N/A. Main Outcome Measures Psychosocial risk assessed using the Stanford Integrated Psychosocial Assessment for Transplant (SIPAT) to derive subscales of Patient's Readiness (PR), Social Support, Psychological Suitability and Psychopathology, and Lifestyle and Effect of Substance Use (LESU), with higher scores signifying greater psychosocial risk. Results Four ANOVA models were run (SIPAT subscale=dependent variable; transplant type=independent variable). Significant effects were found for PR, F(2, 73) = 3.98, p = .023, and LESU, F(2, 73) = 6.18, p = .003. Nonparametric bootstrapped t-tests using 10,000 resamples revealed higher mean scores for liver compared to kidney and SCT groups for PR (95% CI: 0.53 – 3.73, p = .009; 95% CI: 0.27 – 3.84, p = .025, respectively) as well as LESU (95% CI: 1.81 – 6.73, p < .001; 95% CI: 0.28 – 5.88, p = .030, respectively). Confidence intervals for differences among SCT and kidney groups contained zero (PR 95% CI: -1.45 – 1.58, LESU 95% CI: -1.85 – 1.98). Conclusions Patients from different transplant populations may require different rehabilitation/intervention needs to ensure potential listing and general success. Specifically, liver transplant patients may benefit from additional education on the transplant process and encouraging changes in substance use/lifestyle factors. Future research should investigate differences in psychosocial risk as well as the predictive validity of the SIPAT for long-term treatment outcomes (i.e., transplantation) across transplant groups. Author(s) Disclosures N/A. To investigate differences in psychosocial risk profiles among Veteran transplant groups during mental health (MH) pre-transplant evaluations to inform rehabilitation targets to promote transplant listing and general outcomes. Cross-sectional study. VA Hospital. 76 male Veterans ranging in age from 29–86 (M=62.9, SD=8.8) undergoing kidney (n=29), liver (n=31), or stem cell (SCT; n=16) transplantation work-up. Sixty-two percent identified as white, 30% Black, 5% Latinx, and 1% American Indian/Alaska Native (1% declined to answer). N/A. Psychosocial risk assessed using the Stanford Integrated Psychosocial Assessment for Transplant (SIPAT) to derive subscales of Patient's Readiness (PR), Social Support, Psychological Suitability and Psychopathology, and Lifestyle and Effect of Substance Use (LESU), with higher scores signifying greater psychosocial risk. Four ANOVA models were run (SIPAT subscale=dependent variable; transplant type=independent variable). Significant effects were found for PR, F(2, 73) = 3.98, p = .023, and LESU, F(2, 73) = 6.18, p = .003. Nonparametric bootstrapped t-tests using 10,000 resamples revealed higher mean scores for liver compared to kidney and SCT groups for PR (95% CI: 0.53 – 3.73, p = .009; 95% CI: 0.27 – 3.84, p = .025, respectively) as well as LESU (95% CI: 1.81 – 6.73, p < .001; 95% CI: 0.28 – 5.88, p = .030, respectively). Confidence intervals for differences among SCT and kidney groups contained zero (PR 95% CI: -1.45 – 1.58, LESU 95% CI: -1.85 – 1.98). Patients from different transplant populations may require different rehabilitation/intervention needs to ensure potential listing and general success. Specifically, liver transplant patients may benefit from additional education on the transplant process and encouraging changes in substance use/lifestyle factors. Future research should investigate differences in psychosocial risk as well as the predictive validity of the SIPAT for long-term treatment outcomes (i.e., transplantation) across transplant groups.

Psychosocial Assessment of Transplant Candidates: Inter-rater Reliability and Concurrent Validity of the Japanese Version of the Stanford Integrated Psychosocial Assessment for Transplantation.

The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) is a comprehensive instrument developed to provide a standardized, objective, and evidence-based psychosocial evaluation of the main pretransplant psychosocial risk factors that may influence transplant outcomes. Because established assessment procedures or standardized tools designed to perform pre-solid organ transplant psychosocial evaluation are currently unavailable in Japan, the present study aimed to develop and preliminarily validate the Japanese version of the SIPAT. First, the Japanese version of the SIPAT was developed using standard forward-back-translation procedures. Then, the Japanese versions of the SIPAT and the Japanese version of Psychosocial Assessment of Candidates for Transplant were retrospectively and blindly applied to 107 transplant cases by 4 independent raters. The interrater reliability of the scores obtained with the Japanese version of the SIPAT was excellent (Pearson's correlation coefficient=0.86). The concurrent validity of the SIPAT to the Psychosocial Assessment of Candidates for Transplant for each examiner was substantial (Spearman's rank correlation coefficient=-0.66). These findings suggest that the Japanese version of the SIPAT is a promising and reliable instrument. Further research is required to test the predictive validity of the Japanese version of the SIPAT.

The Stanford ALD–exception protocol: Assessment & outcomes of liver transplant recipients with alcohol-related liver disease and limited sobriety using an adaptation of the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT)

The Stanford ALD–exception protocol: Assessment & outcomes of liver transplant recipients with alcohol-related liver disease and limited sobriety using an adaptation of the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT)

Demographic and Psychosocial Characteristics of Lung Transplant Candidates: Single-Center Analysis

Lung transplantation has changed the course of treatment of lung diseases for the better; however, there are various factors that should be considered to increase the probability of a better outcome. Factors such as the patient's background, level of education, and income could affect their perception and eventually the results of the procedure. The present study involved patients who underwent the qualification process for lung transplant along with psychological and sociologic assessment at the Lung Transplant Unit in the Department of Cardiac Surgery and Vascular Surgery, Medical University of Gdansk. The following data were identified in the patients' medical history: marital status, size of the city, source of income, profession, voivodeship, and their Stanford Integrated Psychosocial Assessment for Transplant (SIPAT) score for psychosocial prediction of the outcome. A group of 121 patients were included in the study: 77 (63.64%) men and 44 (36.36%) women. The average age of the patients was 55.4 ± 9.81 years. Eighty (66.12%) lived in the city, and 26 (21.49%) of patients were professionally active with a fixed salary as their source of income. One hundred two patients were married. The median SIPAT score was 10.0 ± 3.0 for men and 10.0 ± 2.75 for women (P=.0974). For optimum care and results of the lung transplant procedure, it is important to consider these background patient factors because they play a crucial role in determining the course of the surgery. The analysis of demographic data is undoubtedly one of the elements helpful in the further fate of the whole process.

Evaluation of the Stanford Integrated Psychosocial Assessment for Transplantation on Clinical Outcomes Following Left Ventricular Assist Device Implantation

<h3>Purpose</h3> The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) is a validated psychosocial risk assessment tool widely used in evaluation of heart transplant candidates. We explored its usefulness and re-purposability in predicting post-operative clinical outcomes in the LVAD patient population. <h3>Methods</h3> 145 patients implanted with a durable LVAD at a US tertiary medical center between January 2010 and April 2020 were retrospectively enrolled. Patients were risk-stratified into three groups by SIPAT score based on commonly accepted thresholds of <6 as excellent (31.7%), 6-20 as good (53.8%), and >20 as acceptable/poor (14.5%). <h3>Results</h3> The enrolled patients were predominantly male (68.3%) with a mean age of 54.8 years and mean overall SIPAT score of 12.4. When defined continuously, SIPAT score was not a significant predictor for survival at 1 year (HR, 0.995; 95% CI, 0.927-1.068; P=0.897) or 3 years (HR, 0.989; 95% CI, 0.942-1.039 P=0.666). There was no significant difference in survival between patient groups of different SIPAT strata at 1 year (P=0.888) or 3 years (P=0.743) or in freedom from readmission at 3 years (P=0.389). Additionally, no differences were observed when subgroup analysis was performed by device type. <h3>Conclusion</h3> Several published studies have reported conflicting findings regarding SIPAT's applicability in the LVAD population. In this contemporary single center study, we showed that SIPAT score has no direct correlation to survival or free from readmission following LVAD implantation. Further study may help identify potential contributors (e.g., implementation of a comprehensive patient/family assistance protocol) to the observed enhanced clinical outcome and reduced disparities.

Composite Lung Transplant Suitability Score (CLaSS): A Novel Predictor of Survival Following Lung Transplantation

<h3>Purpose</h3> Lung transplantation is indicated in patients with respiratory failure who progress despite optimal therapy. The selection of suitable transplant recipients considers internationally accepted absolute and relative contra-indications that are known to negatively influence survival, and typically involves a multi-disciplinary assessment. We assessed the impact on routinely collected pre-transplant variables on post-transplant survival and created a composite model that predicted post-transplant survival. <h3>Methods</h3> Adult patients (n = 916) undergoing lung transplant assessment at a single center between 2013 and 2021 had the following variables analyzed: age, gender, pre-transplant diagnosis, BMI, eGFR, HbA1c, albumin, 6-minute walk distance (6MWD) and Stanford Integrated Psychosocial Assessment for Transplant (SIPAT) score. Logistic regression was performed for post-transplant survival. Multiple imputation was used for missing data. Variables for inclusion in the final model were selected using backward elimination and confirmed using forward elimination (p-value <0.1). Internal validation of the model was performed using-one-out cross validation and 70/30 data split. <h3>Results</h3> Variables as assessed by univariate analysis predicting worse survival included pre-transplant diagnosis (CLAD), limited renal reserve and reduced 6MWD, with CLAD and 6MWD remaining significant predictors of death in the multivariate analysis. All variables were initially included in the predictive model, however the model performance improved with the selective inclusion of pre-transplant diagnosis, 6MWD and HbA1c (ROC 0.672, sensitivity 98.7%). Case examples demonstrated the practical utility of the model. Scenario #1. CF, HbA1c 5, Albumin 40 and 6MWD 400m; predicted probability of survival is 85%. Scenario #2. CLAD, HbA1c 5, albumin 20, 6MWD 250m; predicted probability of survival is 36%. <h3>Conclusion</h3> Using variables that are commonly collected during a pre-transplant assessment, we have created a clinically applicable model that predicts post-transplant survival. The model can aid in recipient selection and inform discussion with potential transplant candidates on expected post-transplant outcomes, including survival.

Predicting Left Ventricular Assist Device Outcomes Utilizing the Stanford Integrated Psychosocial Assessment for Transplant Measure

Objective: Durable mechanical circulatory support is a proven therapy to extend survival for patients with end-stage heart failure (HF). The International Society for Heart and Lung Transplantation guidelines recommend a detailed psychosocial assessment when selecting candidates for durable mechanical circulatory support. Currently, there are no formally validated psychosocial evaluation tools for left ventricular assist device (LVAD) candidacy. The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) uses a multidisciplinary algorithm to evaluate the impact of pre-transplant risk factors on post-transplant outcomes. Emerging literature suggests that the SIPAT might be useful for assessing psychosocial risk factors for LVAD outcomes. Methods: A total of 268 consecutive patients (median age 66 years, 84.6% male) with terminal HF were evaluated before LVAD implantation with a SIPAT assessment. Key outcomes included readmission and mortality rates at 30 days and two years. Results: After screening, 234 subjects met the inclusion criteria and were analyzed. The Patient Readiness subscale of the SIPAT was statistically significant in predicting two-year mortality (B = .167, P &lt; .001; Nagelkerke r2 = .106). Scores on the SIPAT did not correlate to 30-day readmission, 30-day mortality, or two-year readmission rates. Discussion: In this study, only the Patient Readiness score was associated with mortality at two-years post-implantation. This research elucidates the potential longer-term impact of psychosocial factors on LVAD outcomes and the SIPAT’s utility in evaluating LVAD candidacy.

Psychosocial Assessment Rather Than Severity of Liver Failure Dominates Selection for Liver Transplantation in Patients With Alcohol-Related Liver Disease.

The Stanford Integrated Psychosocial Assessment for Transplant (SIPAT) is a validated interview tool to assess psychosocial well-being in candidates for solid organ transplants, with higher scores indicating greater vulnerability. We hypothesized that patients with alcohol-related liver disease (ALD) undergoing liver transplantation (LT) evaluation would have higher SIPAT scores than candidates with non-ALD, but that only patients with ALD who have low scores would be selected. We analyzed retrospectively consecutive adults undergoing LT evaluation from June 2018 to December 2019. Comparisons between patients with ALD and patients with non-ALD were made using the nonparametric Wilcoxon rank sum test plus a multivariate analysis to determine independent predictors for approval. In the study cohort of 358 patients, there were 199 (56%) patients with ALD with a mean age of 55years, and 133 (67%) were men. There were 159 (44%) patients with non-ALD with a mean age of 57years, and 95 (60%) were men. Mean Model for End-Stage Liver Disease-sodium scores were similar for selected versus not selected patients with ALD (25 versus 25.6) and selected versus not selected patients with non-ALD (18.3 versus 17.4), although the ALD group had substantially higher Model for End-Stage Liver Disease scores. Patients with ALD had higher mean SIPAT composite and individual domain scores compared with their non-ALD counterparts. SIPAT scores were not affected by age or sex. Proportionately more candidates with non-ALD were selected compared to candidates with ALD (68% versus 42%; P<0.001; odds ratio for approval of non-ALD versus ALD, 2.9; 95% confidence interval, 1.8-4.7; P<0.001). Composite SIPAT scores were lower in the selected versus nonselected in both ALD and non-ALD groups, although the SIPAT scores were significantly higher in selected patients with ALD (median, 39) than selected patients with non-ALD (median, 23; P=0.001). Psychosocial assessment has a greater influence than acuity of liver failure on the selection of patients with ALD for LT listing, whereas psychosocial assessment has a minor influence on the selection of non-ALD candidates.

Recommendations for Psychosocial Evaluation of VAD candidates: Adoption, completion, and barriers to implementation

BackgroundRecommendations exist to guide clinicians on a comprehensive psychosocial (PS) evaluation prior to Mechanical Circulatory Support (MCS) implantation. ObjectivesAssess adoption, beliefs, methodologies, and barriers to completion of the 2018 ISHLT/APM/AST/ICCAC/STSW Recommendations for Psychosocial evaluation of adult cardiothoracic transplant and long term mechanical circulatory support. MethodsCross-sectional survey distributed to all 183 implanting LVAD centers in North America via mail and email. ResultsTotal of 58 Programs (35.6% response rate) representing 29 states and all regions of the United States responded. Respondents reported implanting 1,183 adults (range 0 – 85; mean = 21.5, SD = 18) in 2018. A majority (n = 55, 94.8%) reported that the 2018 Recommendations were consistent with their clinical practice and most (n = 51, 87.9%) had adopted the recommendations. The Stanford Integrated Psychosocial Assessment for Transplant (SIPAT) (n = 25, 47.1%) was the most commonly cited assessment tool in the use, although 15 centers reported utilizing more than one tool during the assessment process. Most common barriers influencing completion of the PS evaluation include patient too ill (total responses = 104), lack of time (total responses = 89), patient poor candidate (total responses = 44), and lack of Insurance coverage/reimbursement (total responses = 41). ConclusionThe 2018 ISHLT Recommendations for PS evaluation of LVAD Candidates are widely adopted by respondents in clinical practice, although barriers are still reported to their implementation. Additional research is needed to understand strategies to reduce barriers to implementation and maintenance of the recommendations in clinical practice.