Maldonado José R, Sher Yelizaveta, Lolak Sermsak, Swendsen Heavenly, Skibola Danica, Neri Eric, David Evonne E, Sullivan Catherine, Standridge Kim
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.
Psychosom Med. 2015 Nov-Dec;77(9):1018-30. doi: 10.1097/PSY.0000000000000241.
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.
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.
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).
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.
社会心理因素可能会显著影响移植后的结果。斯坦福移植综合社会心理评估（SIPAT）被开发为一种评估工具，以加强移植前的社会心理评估。
我们确定了在我院于2008年6月1日至2011年7月31日期间接受移植且移植前接受SIPAT评估的心脏、肺、肝脏或肾脏移植受者。我们前瞻性地分析了随访1年时积累的社会心理和医学结果。
共确定217例患者并纳入分析。器官衰竭和死亡的主要结局分别发生在12例和21例患者中，且与移植前SIPAT评分无显著相关性。另一方面，SIPAT评分与不良医学和社会心理结局（次要结局）的概率显著相关。事实上，较高的SIPAT评分预示着更高的排斥反应发生率（斯皮尔曼ρ=0.15，95%置信区间[CI]=0.02 - 0.28，p = 0.023）、医疗住院率（ρ=0.29，95%CI = 0.16 - 0.41，p < 0.001）、感染率（p = 0.020）、精神失代偿（p = 0.005）和支持系统衰竭（曲线下面积=0.70，95%CI = 0.60 - 0.79，p < 0.001）。与不依从性的关系显示出一种趋势，但未观察到统计学意义（曲线下面积=0.60，95%CI = 0.50 - 0.71，p = 0.058）。
研究结果表明，SIPAT是一种很有前景的移植前评估工具，有助于识别候选者的社会心理脆弱领域，其评分与移植后的社会心理和医学结局均相关。
