*Purpose: Previous studies suggest the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) is predictive of post-transplant outcomes in multiorgan transplant candidates. We aim to determine the utility of SIPATs in moderate to high risk liver transplant candidates.

*Methods: 168 adult liver transplant candidates with SIPATs reported between January 1^st, 2013 and December 31, 2017, were divided based on SIPAT score: low risk (0-20), minimally acceptable (21-39), and high risk (>40). In a retrospective chart review, we documented demographics, SIPAT, transplant status, incidence of rejection, infection, readmissions within one year, mortality and recidivism. Gender, age, ethnicity, insurance, MELD (Model for End-Stage Liver Disease) score, history of substance abuse and hepatocellular carcinoma were collected during pre-transplant evaluation.

*Results: Of 168 candidates, 70 were listed/transplanted, 98 were not listed. There was a significant difference in mean SIPAT scores who were denied transplant versus those who were listed/transplanted (43±16 vs 31±14, p<0.001).In those patients whose listing was denied, the mortality was 41% vs 11% in those who were listed/transplanted (p<0.001). Fifty-four candidates underwent transplantation: 15 low risk, 28 minimally acceptable, and 11 high risk. No difference was seen in the transplant outcomes of incidence of rejection, infection, readmissions within one year and mortality(table 1).Mean SIPAT score correlated with type of insurer. Higher scores associated with Medicaid-a surrogate for poorer socioeconomic status(p<0.03): 43/54 candidates had a history of substance abuse, with 7/43 (16%) experiencing recidivism. No significance was evident when comparing mean SIPAT of individuals with recidivism and those without (48±18 vs 34 ±13); however, there was when contrasting recidivism of candidates with SIPATs <40 and SIPATs >40 (7/36 vs 4/7; p<0.003).

*Conclusions: The SIPAT is not predictive of most post-transplant outcomes in moderate to high risk liver transplant candidates but there was a significant increase in recidivism in high risk patient. The SIPAT is still useful as a screening tool to mitigate psychosocial risk factors prior to transplantation

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