The association between pre-transplant SIPAT-score and transplant related outcomes in lung and liver transplant patients: a retrospective cohort study.

Abstract

Background: Earlier research showed that psychosocial factors may predict post-transplant medical and psychosocial outcomes. The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) is a tool to conduct the pre-transplant psychosocial screening. Yet there is limited evidence that the SIPAT-score is associated with transplant related outcomes. Aims: Primary aim is to investigate the association between pre-transplant SIPAT-score and transplant related medical outcomes in Dutch lung and liver transplant patients during the first year after transplantation. Secondary, differences in psychosocial outcomes at one year post-transplant between participants with high and low SIPAT-scores were explored. Method: A retrospective cohort study using data from electronic patient files and the TransplantLines Biobank & Cohort study. All adult lung and liver transplant patients who received a single organ in 2016 or 2017 within the participating university hospital were included. Spearman’s rho and logistic regression were used for primary analysis. MannWhitney U-test were used for secondary analysis. Results: No associations were found between the SIPAT-score and duration of the posttransplant hospitalization (p = 0.35), survival (p = 0.51), graft survival (p = 0.34), rejection (p = 0.45), unplanned hospital readmissions (p = 0.67) and number of days re-hospitalized (p = 0.28). Compared to participants with SIPAT-score ≤ 20, participants with SIPAT-scores ≥ 21 showed a higher level of anxiety (p = 0.02), but no significant differences in depression (p = 0.21), medication adherence (p = 0.99) and physical and mental quality of life (p = 0.33 and p = 0.53). Conclusion: Except for anxiety, the pre-transplant SIPAT-score was not associated with medical and psychosocial outcomes one year post-transplant. Recommendation: The SIPAT-score should not be used for selecting transplant-candidates on eligibility. Prospective research is needed to gain insight in the influence of the separate SIPAT-items and domains on medical and psychosocial outcomes.