The Utility of a Pre-Transplant Psychosocial Evaluation in Predicting Post-Transplant Outcomes
Psychosocial evaluations conducted prior to liver transplantation purport to identify risk factors for poor post-transplant outcomes. However, there is insufficient evidence on the predictive validity of such evaluations and little agreement exists regarding which factors should be assessed. We investigated if the pre-transplant psychosocial evaluation overall, or any of its individual variables, have predictive value with respect to post-transplant non adherence and outcomes. We also investigated the predictive utility of a newly developed scale, the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) and whether it was a superior predictor of outcome than the standard psychosocial evaluation. This retrospective chart review included 248 adults transplanted from 2009 to 2013 in a single transplant center. Patients were at least 1-year post-transplant with at least 3 tacrolimus levels. Nonadherence was determined using the medication level variability index (MLVI)—a validated measure of adherence (MLVI > 2.5 = high medication level fluctuation likely due to inconsistent adherence). Outcomes (MLVI and biopsy-proven rejection) were obtained from 1- year post-transplant to time of data collection. Approximately 50% of patients had MLVI > 2.5 suggestive of nonadherence, and 17% experienced an episode of rejection. The study sample was largely comparable to the national sample of liver transplant recipients, except for greater ethnic diversity in our sample. Among all variables, simple and logistic regressions determined that none of the psychosocial variables were significant predictors of MLVI continuously (p = 0.35), MLVI > 2.5 ( p = .52), or rejection (p = 0.60). SIPAT total score was not predictive of MLVI continuously (p = .70), MLVI > 2.5 (p = .14), or rejection (p = 0.87) post-transplant. SIPAT threshold did not predict MLVI (p = .16). Finally, the SIPAT was not a better predictor of MLVI continuously (p = .45), MLVI > 2.5 (p = .42), or rejection (p = 0.49), than the standard psychosocial evaluation. In a large sample with high rates of nonadherence, our non-significant findings challenge the adequacy of current practices and suggest that the presence of any one psychosocial risk factor should not be interpreted to confer risk for poor post-transplant outcomes. The clinical utility of the SIPAT also warrants further investigation.
Social psychology|Social work|Medicine|Psychology
Helcer, Jacqueline, "The Utility of a Pre-Transplant Psychosocial Evaluation in Predicting Post-Transplant Outcomes" (2017). ETD Collection for Fordham University. AAI10273030.