The Utility of the Stanford Integrative Psychosocial Assessment for Transplant (SIPAT) in Predicting Outcomes Before and After Lung Transplantation

Background: Optimizing donor use and achieving maximal survival following lung transplantation (LTx) requires a pre-transplant assessment and selection process 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.

Methods: 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.

Results: Over an 8-yr period dating from December 2012, 914 patients (male 54.4%, mean age 55.2 yrs) were assessed for their suitability for LTx. Patients declined for LTx (n = 152, 16.6%) were older, had reduced functional capacity, nutrition and renal function, but had a higher SIPAT score. Once listed for LTx, higher SIPAT score was not associated with death on the waiting list or reduced survival once transplanted. Variables shown in a multi-variate analysis to be associated with reduced post-LTx survival included a pre-transplant diagnosis of CLAD and a reduced 6-minute walk test (6MWT).

Conclusion: The SIPAT tool allows a standardized assessment of psychosocial suitability for LTx that can be incorporated into a formalized 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.