Stanford Integrated Psychosocial Assessment For Transplantation Scores Research Articles

Alcoholic Etiology, Severity of Liver Disease, and Post-Transplant Adherence Are Correlated with Worse Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) in Liver Transplant Candidates.

Introduction: Psychosocial pre-transplant evaluation in patients undergoing liver transplantation (LT) could help identify those patients at higher risk of pharmacological non-adherence, organ rejection, and mortality. The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) is a validated tool for assessing LT candidates' psychosocial well-being. Data on the ability of the SIPAT evaluation to predict post-transplant outcomes are sparse. Material and Methods: clinical and psychosocial data from a sample of 134 candidates for LT were analyzed. Moreover, the association between pre-transplant psychosocial evaluation and post-transplant clinical outcomes, including organ rejection, mortality, and immunosuppressant drug adherence, was calculated. Results: At the pre-transplant evaluation, patients who showed high SIPAT scores (77, 57%) also had more liver disease assessed by model for end-stage liver disease (MELD; F = 5.04; p < 0.05), alcoholic etiology (F = 35.80; p < 0.001), encephalopathy (F = 5.02; p < 0.05), and portal hypertension (F = 7.45; p < 0.01). Of the 51 transplant patients, those who had a high pre-transplant SIPAT score showed lower post-transplant immunosuppressive adherence, linked to more frequent immunological events. Conclusions: Patients with an alcoholic etiology of liver disease and more severe liver dysfunction are likelier to not adhere to medical prescriptions following transplantation. Current data suggests that this specific group of patients could benefit from early psychological pre-habilitation before undergoing liver transplantation.

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 &amp;gt; 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.

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.

The Stanford Integrated Psychosocial Assessment for Transplantation Score Predicts Frequency of Hospital Readmissions in Left Ventricular Assist Device Patients

Purpose The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) score is a validated tool for determination of psychosocial and behavioral risk in patients who are undergoing evaluation for organ transplant. The total score is comprised of subsets A-D which scores patient's readiness level and illness management, social support system, psychological stability, as well as lifestyle and effect of substance abuse, respectively. Several centers use SIPAT scores to determine suitability of Left Ventricular Assist Device (LVAD) candidates, however SIPAT remains an unvalidated risk assessment tool in this population. The objective of this study is to assess whether SIPAT scores are associated with 1-year hospital readmissions in LVAD patients. Methods SIPAT scores were documented for 121 LVAD patients (mean age: 50.5 years, 36 % female, 56% black, 45% BTT) implanted at Emory University Hospital from 2010 to 2018. Zero inflated poisson regression models were used to examine the association of SIPAT scores and subscales with the number of hospital readmissions within the 1st year after LVAD implantation, adjusted for age, sex, race, INTERMACS profile, BTT versus DT status, eGFR, and albumin. Results The mean total SIPAT score was 7.07 ±7.76, with mean scores on the subscales as follows: SIPAT A:0.94 ± 2.05, SIPAT B:0.98 ± 2.47, SIPAT C:1.42 ± 2.41, SIPAT D:3.63 ± 3.74. In the first year after LVAD implantation, 259 total hospitalizations occurred in 106 patients (87.6% of total patients had at least 1 admission and there were 16 deaths). The total SIPAT score was associated with a higher number of 1-year hospital readmissions with an adjusted HR: 1.02 for 1-point increase in score (95% CI: 1.00-1.04, p=0.012). Specifically, SIPAT A (adjusted HR: 1.12( 95% CI: 1.06-1.21, p Conclusion In LVAD patients, the total SIPAT score, driven by subscales A and D, was associated with an increased risk of 1-year hospital readmissions following LVAD implantation. These findings suggest that these scores may be useful in risk stratifying LVAD patients and highlight the population of patients who require additional support.

The Psychosocial Assessment of Transplant Candidates: Inter-Rater Reliability and Predictive Value of the Italian Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT)

The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) is a comprehensive instrument developed to accurately assess the main pretransplant psychosocial risk factors that may impact transplant outcomes. As neither established assessment procedures nor standardized tools designed to perform pretransplant psychosocial evaluation are currently available in Italy, the present study was designed to develop and preliminarily validate the Italian version of the SIPAT. First, our team developed the Italian version of the SIPAT, following standard forward-back translation procedures. Then, the Italian version of the SIPAT was retrospectively and blindly applied to 118 randomly selected transplant cases (40 heart, 40 lung, and 38 liver) by 2 independent examiners. Information about the patients' final transplant listing recommendation (i.e., listing vs. deferral) was independently collected from the respective transplant teams. The inter-rater reliability of the Italian version of the SIPAT scores was substantial (Cohen's kappa=0.77; P<0.001). Moreover, the predictive value of the SIPAT ratings on the final transplant listing recommendation (i.e., listing vs. deferral) for each examiner was significant (both P<0.05). Current findings suggest that SIPAT is a promising and reliable instrument in its Italian version. Given these excellent psychometric characteristics, the use of the SIPAT as part of the pretransplant psychosocial evaluation in Italian medical settings is highly encouraged.

SIPAT B Score Predicts Mortality in Both BTT and DT Male LVAD Patients

Introduction The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) score assesses psychosocial and behavioral risk in patients who are undergoing evaluation for heart transplant. The SIPAT score is associated with adverse outcomes including increased rates of rejection, admissions and infections post-transplant. Many Stage D heart failure patients will undergo SIPAT testing, with some receiving an LVAD as bridge to transplant (BTT) and other as destination therapy (DT). However, the role of SIPAT scores in left ventricular assist devices (LVAD) patients remains unclear based on a limited number of studies. The objective of this study assesses whether SIPAT scores were associated with increased mortality. Methods SIPAT scores were documented by a Licensed Master Social Worker for 137 LVAD patients (mean age: 50.0±13 years 35.8% female, 59.8% black)including BTT and DT (57.7%) implanted at Emory University Hospital from 2010 to 2018. The total SIPAT score is comprised of 4 subscales that represent different psychosocial domains: A - patient readiness and illness management, B - social support system, C - psychological stability and psychopathology, and D—lifestyle and substance abuse. Multivariable Cox regression models were used to examine the association of SIPAT scores with mortality. Results During a follow-up period of 1.58 years [IQR 0.8-2.87], 53 patients (38.7%) died. The mean total SIPAT score was 7.45 ±8.06, and 92.0% of patients classified as excellent-good candidates (total SIPAT score ≤20). There was no association between total SIPAT scores and mortality in the total cohort. However, the SIPAT B subscale was associated with mortality in men after adjusting for age, race, albumin, and renal function (SIPAT B *sex interaction P=0.009). Men who died had a higher mean score on the SIPAT B subscale than those who did not (2.00 ± 3.65 vs. 0.63 ± 1.63, p=0.05). Sex-stratified Cox models demonstrated that the SIPAT B subscale was associated with mortality in men (adjusted HR: 1.39, 95% CI 1.11-1.75, p=0.004); but not in women (p=0.4). Conclusions In patients with LVAD, the SIPAT B subscale was associated with an increased risk of mortality in men. These findings suggest that social support may play an even greater role for male patients with LVAD as compared to females. More research is needed to determine which factors clearly define the association between social support and mortality in the LVAD population.

Standardized Use of the Stanford Integrated Psychosocial Assessment for Transplantation in LVAD Patients

BackgroundIncreased psychosocial risk portends poor outcomes following heart transplantation. The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) is a validated, psychosocial risk assessment tool that helps stratify candidates for transplantation. We assessed the impact of psychosocial factors as measured by the SIPAT on clinical outcomes following left ventricular assist device (LVAD) implantation at our institution. Methods and ResultsA total of 115 individuals (mean age: 57 years, 75.6% men) who underwent LVAD implantation, for either bridge-to-transplant (63%) or destination therapy, from 2014 to 2016 were included for analysis. Correlations between SIPAT scores, baseline characteristics, and post-LVAD outcomes were assessed through a retrospective correlational design. At 1 year post-LVAD, the higher risk SIPAT group had more emergency department visits, urgent clinic visits, and readmissions in univariate analysis (rate ratio 1.7 [95% confidence interval (CI) 1.0–2.7, P = .035]). After multivariate analysis, this association retained near-statistical significance (rate ratio 1.6 [95% CI 1.0–2.8, P = .051]). There was also a trend toward more device-associated infections (rate ratio 2.1 [95% CI 0.96–4.4, P = .064]). There was no difference in incidence of other adverse events or 1-year mortality between the 2 groups. ConclusionsHigher psychosocial risk per SIPAT in patients undergoing LVAD implantation is associated with more emergency room visits, urgent visits and readmissions over 1 year, but not LVAD-related complications or mortality. Use of the SIPAT tool may help identify patients at higher risk for hospitalization and/or urgent care beyond traditional factors, but should not preclude LVAD implantation.

Exploration of the Stanford Integrated Psychosocial Assessment for Transplantation With Psychosocial and Medical Outcomes in Kidney and Kidney-Pancreas Transplant Recipients.

The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) is a psychometric instrument designed to assess patient risk for transplant. We investigated the association between SIPAT scores and demographic data with psychosocial and medical outcomes within a diverse kidney/kidney-pancreas transplant population. The SIPAT was administered to all pretransplant candidates. A retrospective review of transplanted patients who had at least 6 months of follow-up was completed. The sample included 136 patients: male (n = 77 [57%]) with a mean age of 47 years old. Thirty-eight percent were black (n = 51), 55% had less than a high school education (n = 74), and 65% had low socioeconomic status (n = 89). Statistical difference was found among SIPAT scores and substance use and support system instability (P = .035, P = .012). Females (P = .012) and patients with a history of psychopathology (P = .002) developed or had a relapse of psychopathology following transplant. Patients with more than a high school education (P = .025) and who were less than 30 years (P = .026) had higher rejection incidence rates. Risk factors for rehospitalizations included Hispanic race, diabetes, and low socioeconomic status (P = .036, P = .038, P = .014). African American/Black and male patients had higher incidence of infection events (P = .032, P = .049). Mortality and treatment nonadherence were not significantly associated with SIPAT scores or demographic variables. The SIPAT was associated with posttransplant substance use and support system instability, while demographic variables were associated with the development and/or relapse of psychopathology, graft loss, rejection, infection events, and medical rehospitalizations. Revision of the SIPAT to include additional demographic components may lend to improved prediction of transplant outcomes.

Psychosocial Contraindications to Heart Transplant Listing in an Urban Academic Medical Center

Purpose Psychosocial assessment is a key component of heart transplantation (HT) evaluation. Criteria such as patient compliance to medical therapy, level of social support, and history of substance abuse are important considerations when assessing appropriateness for listing. The aim of this study was to characterize the patients who do not satisfy listing criteria due to psychosocial criteria and assess the reasons for which they are rejected. Methods We conducted a retrospective review of patients in a large urban medical center who were evaluated for HT between 4/14-5/18. Psychosocial evaluations were completed using the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT). Reasons for HT denial were collected from documentation of patient cases presented at weekly transplant listing meetings. Results Out of 277 patients evaluated, 113 were not listed: 68 (60%) due to only medical reasons, 26 (23%) due to only psychosocial reasons, and 19 (17%) due to both. The most common psychosocial contraindications were inadequate social support (42%), substance abuse (29%), and noncompliance (22%). Patients denied HT had worse overall SIPAT scores than patients listed for HT (16.7 ± 10.4 vs 12.8 ± 7.5, p = 0.026), and specifically scored poorer on patient readiness (5.6 ± 3.9 vs 3.9 ± 2.7, p = 0.002) and social support (4.4 ± 4.5 vs 2.4 ± 2.8, p < 0.001). The SIPAT domains of psychopathology and lifestyle/substance abuse were not significantly different between the two groups (figure). Conclusion Psychosocial barriers are a common cause of rejection for HT listing. Patient readiness and social support are the two factors that are most strongly associated with rejection for HT listing for psychosocial reasons. Psychosocial assessment is a key component of heart transplantation (HT) evaluation. Criteria such as patient compliance to medical therapy, level of social support, and history of substance abuse are important considerations when assessing appropriateness for listing. The aim of this study was to characterize the patients who do not satisfy listing criteria due to psychosocial criteria and assess the reasons for which they are rejected. We conducted a retrospective review of patients in a large urban medical center who were evaluated for HT between 4/14-5/18. Psychosocial evaluations were completed using the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT). Reasons for HT denial were collected from documentation of patient cases presented at weekly transplant listing meetings. Out of 277 patients evaluated, 113 were not listed: 68 (60%) due to only medical reasons, 26 (23%) due to only psychosocial reasons, and 19 (17%) due to both. The most common psychosocial contraindications were inadequate social support (42%), substance abuse (29%), and noncompliance (22%). Patients denied HT had worse overall SIPAT scores than patients listed for HT (16.7 ± 10.4 vs 12.8 ± 7.5, p = 0.026), and specifically scored poorer on patient readiness (5.6 ± 3.9 vs 3.9 ± 2.7, p = 0.002) and social support (4.4 ± 4.5 vs 2.4 ± 2.8, p < 0.001). The SIPAT domains of psychopathology and lifestyle/substance abuse were not significantly different between the two groups (figure). Psychosocial barriers are a common cause of rejection for HT listing. Patient readiness and social support are the two factors that are most strongly associated with rejection for HT listing for psychosocial reasons.

Standardized Psychosocial Assessment Before Left Ventricular Assist Device Implantation.

Before consideration of advanced cardiac therapies, guidelines recommend a comprehensive multidisciplinary examination, including psychosocial assessment. The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) has emerged as a highly reproducible tool to assess for psychosocial impairment and is associated with negative medical and psychosocial outcomes after transplantation. We sought to assess the association between SIPAT and outcomes after left ventricular assist device. We evaluated 128 patients implanted with a first left ventricular assist device at the Cleveland Clinic from 2013 to 2017 who underwent a prospectively collected quantitative psychosocial assessment using SIPAT. Several survival analyses were performed testing the association between SIPAT score and mortality, first adverse event (defined as hospitalization, device exchange, or death), and recurring adverse events after multivariable adjustment. Median SIPAT score was 14 (interquartile range, 9.5-22.5), with higher values (representing more impairment) seen in patients implanted as destination therapy. After a median follow-up of 349 (interquartile range, 178-684) days, there were 319 adverse events (18 deaths, 10 device exchanges, and 291 readmissions) with 2.5±2.4 events per patient. Higher preimplant SIPAT scores were not associated with mortality ( P=0.764) or time to a first adverse event ( P=0.589) but were associated with cumulative adverse events (hazard ratio, 1.31; 95% CI, 1.09-1.58; P=0.005 per Δ10 in score). In addition, SIPAT was associated with days alive outside of the hospital ( P=0.016). A standardized assessment of psychosocial impairment after left ventricular assist device using the SIPAT score was not associated with mortality or time to first adverse event but was associated with cumulative adverse cardiac events. This score may provide insight when structuring mitigation strategies for high-risk patients and should be further tested in a prospective multicenter study.

The value of Stanford integrated psychosocial assessment for transplantation (SIPAT) in prediction of clinical outcomes following left ventricular assist device (LVAD) implantation

BackgroundThe Stanford integrated psychosocial assessment for transplantation (SIPAT) is a validated psychosocial evaluation tool in the transplant population. ObjectiveWe evaluated SIPAT in predicting post-left ventricular assist device (LVAD) outcomes, including cumulative re-admissions, driveline infections, pump malfunction, pump thrombosis, gastrointestinal bleeding, major bleeding, stroke and right ventricular failure. MethodsThis retrospective study included 50 LVAD patients at an academic institution in the United States who had a pre-implant SIPAT score during the years 2015-2017. Patients were split into two groups based on SIPAT score, separating a “excellent”/“good” from a “minimally acceptable”/“poor” candidate. Poisson regression, using SIPAT as both a categorical and continuous variable, was used to compare the incidence rates of the primary outcome of cumulative re-admissions and secondary outcomes of LVAD complications. ResultsThe patient cohort was predominantly male 93.5% vs 89.4% (p = 0.629) with a median age of 67.0 vs 58.0 years (p = 0.037), planned destination therapy 48.4% vs 68.4% (p = 0.242) and median LVAD follow-up time of 241 vs 379 days (p = 0.10) in the low- and high- SIPAT groups, respectively. SIPAT was not a significant predictor for cumulative re-admissions, but there was an association between higher SIPAT scores and major bleeding. ConclusionIn this single-center retrospective study, SIPAT did not predict cumulative re-admissions. Further study is required to validate SIPAT before clinical implementation.

Utility of the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) in hematopoietic stem cell transplantation (HSCT).

10046 Background: The SIPAT is used to assess psychosocial risk in solid organ transplants but data in HSCT is lacking. We examined if pre-HSCT SIPAT scores predict mortality, morbidity, length of stay (LOS) and number of hospitalizations over a 1 year period. Methods: 89 adult HSCT (59% autologous, 38% allogeneic) pts from an academic medical center underwent the SIPAT pre-HSCT. Additional data were obtained on Day 0, and 3-, 6-, and 12-months. Univariable Cox proportional hazards models assessed the instantaneous risk of mortality at any given time after Day 0 as a function of baseline pt characteristics and the SIPAT score. Results: TheSIPAT categorized 28%, 66% and 5.7% respectively of the pts as excellent (E), good (G), and high risk (HR) candidates. One year post HSCT, 76% of E, 72% of G, and 40% of HR candidates were alive. Higher SIPAT scores were a significant predictor of mortality. Compared to E candidates, the HR candidates were 5.94 (95% CI: 1.31-26.81) times more likely to die any time after Day 0 – even after controlling for pts’ comorbidity index ( p = .02). Similarly, compared to G candidates, HR pts were 4.81 (95% CI: 1.33-17.47) times more likely to die even after controlling for pts’ comorbidity index ( p = .01). There was no difference between the G and E candidates on univariable ( p = .75) or multivariable analysis controlling for comorbidity index score ( p = .72). For every 1 point increase in pts’ adherence score, the risk of death was expected to decline by approximately 14% ( HR = 0.86, 95% CI: 0.78 – 0.96; p = .01). SIPAT items that predicted mortality were depression ( p = .02), deceptive behavior ( p &lt; .001) and moderate alcohol abuse ( p &lt; .001). In linear regression analysis, higher SIPAT score was associated with longer LOS ( p = .04) but not infection ( p = .23), GVHD ( p = .40), or number of hospitalizations ( p = .73). Because there were only 18 mortality events, multivariable analyses were limited. Future research will examine the effect of SIPAT on time to death controlling for other pt comorbidities. Conclusions: We found the SIPAT was able to predict mortality and LOS in HSCT pts. This finding if validated in a multi-center manner could be an important tool for HSCT pt selection.

Evaluation of the SIPAT instrument to assess psychosocial risk in heart transplant candidates: A retrospective single center study

ObjectivesWe evaluated the reliability of the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) in heart transplant (HT) recipients and explored its usefulness in predicting post-transplant outcomes. BackgroundPre-transplant psychosocial and behavioral risk is associated with post-transplant clinical outcomes. SIPAT is a risk assessment tool created for pre-transplant psychosocial evaluation. MethodsVia retrospective chart review, three examiners applied the SIPAT to 51 adult HT recipients. Examiners blinded to SIPAT scores extracted data and interviewed clinicians for one-year post-transplant outcomes. Analysis included Intra-class correlation coefficient (ICC), Pearson's correlation coefficient and Chi-square. ResultsSIPAT demonstrated strong inter-rater reliability (ICC = 0.89, 95% CI = 0.76–0.96). Compared to those with SIPAT ratings of “Excellent/Good”, the “Minimally Acceptable Candidate/High Risk” group was more likely to miss clinic visits (p = 0.004). ConclusionsThe SIPAT tool had strong IRR. Less favorable SIPAT ratings were associated with nonadherence to clinic visits. Further study is warranted to determine association of SIPAT ratings to clinical outcomes.

The Stanford Integrated Psychosocial Assessment for Transplantation: A Prospective Study of Medical and Psychosocial Outcomes.

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.

Quality Improvement Project to Reduce Heart Failure Readmissions at Robley Rex Veterans’ Affairs Hospital (VAH) - Louisville, KY

Background:Maldonado and colleagues identified and weighed key psychosocial elements that could predict transplant outcomes. Based on this work, they developed an instrument, the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) which addressed the need for an evidence-based transplant psychosocial-evaluation instrument. The purpose of this study is to assess the ability of the SIPAT to determine candidacy for transplant and/or LVAD in our patient population.Methods: The SIPAT was used during pre-heart psychosocial evaluations to assign a score and risk category for 130 consecutive patients evaluated for heart transplant and/or LVAD implant at Houston Methodist Hospital from March, 2012 through March, 2013. We assessed these scores and 1 year outcomes after initial evaluation. Kaplan-Meier curves were constructed for 1 year overall survival. Results: In the final study population of 100 patients we found that 12 candidates with SIPAT scores over 40 (high psychosocial risk) were not transplanted but 3 received LVAD (left ventricular assist device). Moreover, 5 candidates with scores over 40 had a high mortality rate postsurgery. Finally, 27 patients in the minimally acceptable candidate score range 21-39 had the best survival rate overall. Conclusion: Higher SIPAT scores are associated with higher one year mortality for LVAD support. More work is needed on elucidating whether and how the SIPAT is associated with mortality for patients in the moderate risk categories. The SIPAT also has utility in evaluating candidacy for mechanical circulatory support.

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

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.

The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT): A New Tool for the Psychosocial Evaluation of Pre-Transplant Candidates

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.