Jacqueline H Becker1,2, Eyal Shemesh2, Akhil Shenoy3, Ailie Posillico4, Christopher S Knight4, Se-Kang Kim4, Sander S Florman5, Thomas Schiano5, Rachel A Annunziato2,5. 1. Department of Medicine, 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA. 2. Department of Pediatrics, 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA. 3. Center for Liver Disease and Transplantation, 21611Columbia University Medical Center, New York, NY, USA. 4. Department of Psychology, 5923Fordham University, Bronx, NY, USA. 5. 52100Recanati/Miller Transplantation Institute/Division of Liver Disease, Mount Sinai Medical Center, New York, NY, USA.
Abstract
BACKGROUND: There is insufficient evidence about the ability of pretransplant psychosocial evaluations to predict posttransplant outcomes. While standardized assessments were developed to increase predictive validity, it is unclear whether the risk scores they yield predict outcomes. We investigated if the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT), a scaling approach to those assessments, would have been a superior predictor than the standard psychosocial evaluation. METHODS: In this retrospective study, medical records of 182 adult liver transplant recipients who were at least 1 year posttransplant and prescribed tacrolimus for immunosuppression were analyzed. Regression analyses predicted outcomes of interest, including immunosuppressant nonadherence and biopsy-proven rejection, obtained 1-year posttransplant to time of data collection. Nonadherence was determined using the medication level variability index (MLVI). RESULTS: Approximately 49% of patients had MLVI > 2.5, suggestive of nonadherence, and 15% experienced rejection. SIPAT total score did not predict adherence either using the continuous (P = .70), or dichotimized score, above or below > 2.5 (P = .14), or rejection (P = 0.87). Using a SIPAT threshold (total score > 69) did not predict adherence (p = .16) nor was a superior predictor of the continuous adherence score (P = .45), MLVI > 2.5 (P = .42), or rejection (P = 0.49), than the standard evaluation. CONCLUSION: Our findings suggest that the SIPAT is unable to predict 2 of the most important outcomes in this population, immunosuppressant adherence and rejection. Research efforts should attempt to evaluate the best manner to use psychosocial evaluations.
BACKGROUND: There is insufficient evidence about the ability of pretransplant psychosocial evaluations to predict posttransplant outcomes. While standardized assessments were developed to increase predictive validity, it is unclear whether the risk scores they yield predict outcomes. We investigated if the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT), a scaling approach to those assessments, would have been a superior predictor than the standard psychosocial evaluation. METHODS: In this retrospective study, medical records of 182 adult liver transplant recipients who were at least 1 year posttransplant and prescribed tacrolimus for immunosuppression were analyzed. Regression analyses predicted outcomes of interest, including immunosuppressant nonadherence and biopsy-proven rejection, obtained 1-year posttransplant to time of data collection. Nonadherence was determined using the medication level variability index (MLVI). RESULTS: Approximately 49% of patients had MLVI > 2.5, suggestive of nonadherence, and 15% experienced rejection. SIPAT total score did not predict adherence either using the continuous (P = .70), or dichotimized score, above or below > 2.5 (P = .14), or rejection (P = 0.87). Using a SIPAT threshold (total score > 69) did not predict adherence (p = .16) nor was a superior predictor of the continuous adherence score (P = .45), MLVI > 2.5 (P = .42), or rejection (P = 0.49), than the standard evaluation. CONCLUSION: Our findings suggest that the SIPAT is unable to predict 2 of the most important outcomes in this population, immunosuppressant adherence and rejection. Research efforts should attempt to evaluate the best manner to use psychosocial evaluations.
Authors: José R Maldonado; Yelizaveta Sher; Sermsak Lolak; Heavenly Swendsen; Danica Skibola; Eric Neri; Evonne E David; Catherine Sullivan; Kim Standridge Journal: Psychosom Med Date: 2015 Nov-Dec Impact factor: 4.312
Authors: P Sacco; S Sultan; M Tuten; J M Powell; M Connelly; R N Barth; M Hodorowicz; J C LaMattina Journal: Transplant Proc Date: 2018-07-09 Impact factor: 1.066
Authors: Mary Amanda Dew; Andrea F DiMartini; Fabienne Dobbels; Kathleen L Grady; Sheila G Jowsey-Gregoire; Annemarie Kaan; Kay Kendall; Quincy-Robyn Young; Susan E Abbey; Zeeshan Butt; Catherine C Crone; Sabina De Geest; Christina T Doligalski; Christiane Kugler; Laurie McDonald; Linda Ohler; Liz Painter; Michael G Petty; Desiree Robson; Thomas Schlöglhofer; Terry D Schneekloth; Jonathan P Singer; Patrick J Smith; Heike Spaderna; Jeffrey J Teuteberg; Roger D Yusen; Paula C Zimbrean Journal: Psychosomatics Date: 2018-07-10 Impact factor: 2.386
Authors: Sarah K Fineberg; Adrienne West; Peter Jongho Na; Mark Oldham; Michael Schilsky; Keith A Hawkins; Hochang Benjamin Lee Journal: Gen Hosp Psychiatry Date: 2016-01-22 Impact factor: 3.238