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Transplant psychiatry

Journal Article Annotations
2020, 4th Quarter

Transplant psychiatry

Annotations by Sarah Andrews, MD, Shehzad K. Niazi, MD, FRCPC
December, 2020

  1. Psychosocial Outcomes of Donors Whose Recipients Died After Living Donor Liver Transplantation
  2. The Utility of a Pre-Transplant Psychosocial Evaluation in Predicting Post-Liver Transplant Outcomes
  3. The Stanford Integrated Psychosocial Assessment for Transplant is Associated with Outcomes Before and After Liver Transplantation

    PUBLICATION #1 — Transplant psychiatry

    Psychosocial Outcomes of Donors Whose Recipients Died After Living Donor Liver Transplantation
    Mukadder Ispir, Birgul Cumhur, Tolga Sahin, Emrah Otan, Cuneyt Kayaalp, Sezai Yilmaz

    Annotation

    The finding:
    This cross-sectional study evaluated the psychosocial outcomes of donors whose recipients died after living donor liver transplantation, comparing them to donors whose recipients survived. Between 2012 and 2017 at a transplantation center in Turkey, 41 donors whose recipients died were compared to 87 donors with living recipients. Donors whose recipients died had increased levels of psychosocial burden, including increased rates of anxiety and depression. These donors also experienced increased regret and hopelessness. 

    Strength and weaknesses:
    The study focuses on the importance of evaluating the psychosocial stressors associated with living donation, specifically the long-term consequences based on recipient survival. One of the weaknesses was that the participation rate was only 25% in donors, which raises the concern of selection bias. 

    Relevance:
    This study is relevant for C-L psychiatrists who evaluate or manage the transplant population. Living donors should be well-educated on the potential negative effects of donation, specifically if the recipient does not survive. Living donors should be made aware of the possible regret that can occur based on recipient outcome. 

    Type of study (EBM guide):
    Cross-section study


    PUBLICATION #2 — Transplant psychiatry

    The Utility of a Pre-Transplant Psychosocial Evaluation in Predicting Post-Liver Transplant Outcomes
    Becker JH, Shemesh E, Shenoy A, Posillico A, Knight CS, Kim SK, Florman SS, Schiano T, Annunziato RA.

    Annotation

    The finding:
    This retrospective study analyzed 182 adult liver transplant recipients at least one year post-transplant, comparing their results from the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) with outcomes post-transplant. Nonadherence was evaluated through biopsy-proven rejection. SIPAT was ineffective in predicting nonadherence in patients post-transplant. 

    Strength and weaknesses:
    The strength of this study was appropriate regression analyses predicting outcomes and comparing pre-transplant assessments with post-transplant adherence. One weakness is that only transplanted patients were included in the analyses, and thus skewing results. Further, raters for the SIPAT may have not accurately identified all risks. 

    Relevance:
    This study is relevant for C-L psychiatrists as we complete psychosocial evaluations for patients pre-transplant. Part of the evaluation process is a psychosocial evaluation and attempting to predict adherence post-transplant, however patients may present differently pre-transplant as compared to reality of behaviors post-transplant. We need to continue assessing psychosocial risk and to further explore how to predict outcomes. 

    Type of study (EBM guide):
    Retrospective study


    PUBLICATION #3 — Transplant psychiatry

    The Stanford Integrated Psychosocial Assessment for Transplant is Associated with Outcomes Before and After Liver Transplantation
    Deutsch-Link S, Weinberg EM, Bitterman T, McDougal M, Dhariwal A, Jones LS, Weinrieb RM, Banerjee AG, Addis S, Serper M.

    Annotation

    The finding:
    Authors of this study demonstrate that patients with higher risk SIPAT score, using a cut-off of 21, were less likely to be waitlisted for transplant. Patients with 21 or higher SIPAT scores were also less likely to adhere with immunosuppressant medications post-transplant. Additionally, the study subjects with higher scores in readiness domain of SIPAT were at a higher risk of graft rejection.

    Strength and weaknesses:
    Even though this study was conducted at a single center, yet the study cohort is relatively diverse and large. Transplant team evaluated 1430 patients and of those the researchers analyzed 384 recipients for post-transplant outcomes. Only the clinical social workers assigned SIPAT scores, and transplant psychiatrists did not assign scores independently. Authors performed appropriate statistical analyses and conclusions are supported by the study findings. Study’s duration does allow authors to study outcomes beyond 1-year post transplant in some patients but further longitudinal follow up may provide additional information regarding SIPAT-score and transplant outcomes. An additional strength is that authors do explore gender, education and community health scores related covariates and their impact on scores, likelihood for listing and outcomes as social determinants of health and issues of equity remain important and active areas of study.

    Relevance:
    Transplant team has to carefully evaluate all potential transplant candidates. Transplant psychiatrists and social workers play a key role in assessing these patients to identify any relevant psychosocial factors that can increase the risk of poorer outcomes after transplant. However, such evaluations need to be individualized and standardized where possible. Tools such as SIPAT are used to inform psychosocial evaluations. This study contributes to the accumulating evidence base to support the utility and validity of SIPAT.

    Type of study (EBM guide):
    Retrospective case-control study