Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Hall C & D
*Purpose: The Stanford Integrated Psychosocial Assessment for Transplant (SIPAT) score is a comprehensive tool that was developed to standardize pretransplant psychosocial evaluations and has been shown to predict post transplant rejection, hospitalization, infections and psychiatric decompensation. However, it has not been validated to predict post liver transplant alcohol relapse and therefore our study aimed to retrospectively assess the ability of the SIPAT score to predict recidivism after transplant.
*Methods: We performed a retrospective prognostic study by querying our centers post liver transplant list (2013 – 2018) for adult patients who underwent chemical dependency committee evaluations by a multidisciplinary team of transplant caregivers prior to their transplantation. The decision to select patients who underwent chemical dependency evaluation was based on recent alcohol intake. Cohorts were defined by our center as high risk (HR), SIPAT score greater than or equal to 40, and low risk (LR) groups, SIPAT score less than 40. They were then compared using univariate tests of association and risk adjusted multivariate models. Our primary outcome was recidivism which was defined by any evidence (historical or laboratory) evidence of alcohol intake after transplantation.
*Results: Our center transplanted 238 patients since inception in 2013. We found that 35 (15%) of these patients were evaluated by the chemical dependency committee with SIPAT scores prior to transplantation. Median age was 53 years (IQR 49 – 57). 71% (n=25) of these patients were male. There was no differences between groups with regards to gender, marital status, illicit drug use, and ETOH abstinence quit time. We did find the HR cohort was significantly younger (median 43 years, IQR 39 – 53) compared to the LR cohort (median 55 years, IQR 48 – 64). We found that 42% of the HR cohort had recidivism compared to the LR cohort 4% (Pearson X2 p-value 0.0097). We found that incidence of post operative organ rejection was seen in 28% of the HR cohort and 21% of the LR cohort (Pearson X2 p-value 0.68).
*Conclusions: This study demonstrates the efficacy of using SIPAT score to predict recidivism in patients with a history of recent alcohol intake who then undergo liver transplantation. Further research is warranted to help identify what factors truly predict alcohol use recurrence post transplant.This vital knowledge is paramount and will have a significant impact on providing life saving liver transplantation for a group that has historically been denied such access.
|Characteristic||Low risk SIPAT (n=28)||High risk SIPAT (n=7)||p value|
|Age, median years||55||43|
|Gender, male (%)||23 (82)||4 (57)||0.15|
|Marital status, married (%)||18 (68)||6 (85)||0.27|
|History of illicit substance use (%)||4 (14)||2 (29)||0.80|
|Time since last alcoholic drink, median months||8.5||5|
|Recidivism post transplantation||1 (4)||3 (42)||0.009|
|Rejection of transplanted liver||6 (21)||3 (42)||0.15|
To cite this abstract in AMA style:Rahman AUr, Singh H, Abusaif M, Shaw J, Knighton O, Clark L, Santos T, Ebaid S, Reino D, Vanatta J, Tzakis A, Alkhalloufi K, Zervos X. Utility Of SIPAT Scoring System In Predicting Risk Of Recidivism In Patients With Alcoholic Liver Disease. [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/utility-of-sipat-scoring-system-in-predicting-risk-of-recidivism-in-patients-with-alcoholic-liver-disease/. Accessed September 22, 2019.
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