title: The Stanford Integrated Psychosocial Assessment for Transplantation: A Prospective Study of Medical and Psychosocial Outcomes.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: From the Department of Psychiatry & Behavioral Sciences (Maldonado, Neri, Sher, Skibola, Sullivan), Stanford University School of Medicine, Stanford, California; George Washington University School of Medicine and Health Science (Lolak), Washington, DC; Psychosomatic Medicine Research Laboratory (Swendsen), Stanford University, Stanford, California; Department of Social Services (David), Lucille Packard Children Hospital, Stanford, California; and Solid Organ Transplant Service Line (Standridge), Stanford Hospital and Clinics, Stanford, California.
authors.forename: José R
authors.initials: JR
authors.lastname: Maldonado
authors.forename: Yelizaveta
authors.initials: Y
authors.lastname: Sher
authors.forename: Sermsak
authors.initials: S
authors.lastname: Lolak
authors.forename: Heavenly
authors.initials: H
authors.lastname: Swendsen
authors.forename: Danica
authors.initials: D
authors.lastname: Skibola
authors.forename: Eric
authors.initials: E
authors.lastname: Neri
authors.forename: Evonne E
authors.initials: EE
authors.lastname: David
authors.forename: Catherine
authors.initials: C
authors.lastname: Sullivan
authors.forename: Kim
authors.initials: K
authors.lastname: Standridge
mesh_terms: D000293:Adolescent; D000328:Adult; D001007:Anxiety / Q000523:psychology; D003072:Cognition Disorders / Q000523:psychology; D003863:Depression / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006760:Hospitalization; D006801:Humans; D007239:Infections / Q000453:epidemiology / Q000523:psychology; D007406:Interview, Psychological; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000523:psychology; D008875:Middle Aged; D016377:Organ Transplantation / Q000401:mortality / Q000523:psychology*; D010349:Patient Compliance / Q000523:psychology; D011183:Postoperative Complications / Q000453:epidemiology / Q000523:psychology; D011300:Preoperative Care; D011446:Prospective Studies; D011581:Psychological Tests; D019966:Substance-Related Disorders / Q000523:psychology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult