The Utility of a Pre-Transplant Psychosocial Evaluation in Predicting Post-Liver Transplant Outcomes.
Jacqueline H Becker, Eyal Shemesh, Akhil Shenoy and 6 others
PMID 33272096WHAT IT FOUND
In 182 liver transplant patients, a pretransplant psychosocial risk score did not predict later rejection or medication adherence.
The standard evaluation performed no better. Clinicians should not rely on this score alone to judge posttransplant risk.
Key findings
01The SIPAT total score did not predict biopsy-proven rejection after transplant.
02The SIPAT total score did not predict medication adherence, measured by tacrolimus level variability.
03The SIPAT total score was not a better predictor of rejection than the standard pretransplant variables.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The SIPAT score was reconstructed from old charts after transplant, not assigned prospectively, so missing or unclear documentation could have changed the score. Missing chart information excluded 27% of the site's adult liver transplant population, and the authors note this may have selected for patients with more psychosocial concerns. Only patients who received a transplant were included, so the study does not address patients who were not transplanted. The study was not blinded; patients identified as high risk may have received closer monitoring, which could reduce the outcomes being studied. Adherence was estimated from tacrolimus level variability, not directly observed medication-taking. It was a single-center study, so results may not generalize to other transplant centers.
Declared interests
The authors declared no potential conflicts of interest. The article is listed as research support from NIH, extramural.
The easy way to misread this
Do not conclude that psychosocial risk before liver transplant does not matter. The study tested one retrospectively scored instrument, not all psychosocial assessment, and the authors say the retrospective design requires cautious interpretation.