Association of Psychosocial Risk Factors and Liver Transplant Evaluation Outcomes in Metabolic Dysfunction-associated Steatotic Liver Disease

Overview

Journal Liver Transpl

Specialties Gastroenterology
General Surgery

Date 2024 Jun 13

PMID 38869989

Authors

Roy X Wang

Jason J Lee

Danielle Mirda

Jinxuan Hao

Anna M Goebel

Sasha Deutsch-Link

Marina Serper

Therese Bittermann

Affiliations

Soon will be listed here.

Abstract

The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) is a standardized psychosocial assessment tool used in liver transplantation (LT) evaluation and has been primarily studied in patients with alcohol-associated liver disease. We aimed to evaluate the relationship between SIPAT score and metabolic syndrome severity and LT waitlist outcomes in a large cohort of patients with metabolic dysfunction-associated steatotic liver disease (MASLD). We performed a single-center retrospective cohort study of patients with MASLD evaluated for LT from 2014 to 2021. The utility of the previously defined total SIPAT cutoff (<21 [excellent/good candidates] vs. ≥21 [minimally acceptable/high-risk candidates]) was studied. Multivariable logistic regression analyses examined associations between continuous SIPAT scores and LT waitlisting outcomes. The Youden J statistic was used to identify the optimal SIPAT cutoff for patients with MASLD. A total of 480 patients evaluated for transplant with MASLD were included. Only 9.4% of patients had a SIPAT score ≥21. Patients with SIPAT score ≥21 had higher hemoglobin A1c compared to patients with lower psychosocial risk (median [IQR]: 7.8 [6.0-9.7] vs. 6.6 [5.8-7.9]; p = 0.04). There were no other differences in metabolic comorbidities between SIPAT groups. Increasing SIPAT score was associated with decreased odds of listing (OR: 0.82 per 5-point increase; p = 0.003) in multivariable models. A SIPAT of ≥12 was identified as the optimal cutoff in this population, resulting in an adjusted OR for a listing of 0.53 versus SIPAT <12 ( p = 0.001). In this large cohort of patients with MASLD evaluated for LT, few patients met the previously defined high SIPAT cutoff for transplant suitability. Nevertheless, increasing the SIPAT score was associated with waitlist outcomes. Our suggested SIPAT cutoff of ≥12 for patients with MASLD warrants further external validation using data from other centers.

References

Rosenberger E, Dew M, Crone C, DiMartini A . Psychiatric disorders as risk factors for adverse medical outcomes after solid organ transplantation. Curr Opin Organ Transplant. 2012; 17(2):188-92. PMC: 4470498. DOI: 10.1097/MOT.0b013e3283510928. View

Martin S, Bosse J, Wilson A, Losikoff P, Chiodo L . Under one roof: identification, evaluation, and treatment of chronic hepatitis C in addiction care. Addict Sci Clin Pract. 2018; 13(1):10. PMC: 5937807. DOI: 10.1186/s13722-018-0111-7. View

Forlano R, Harlow C, Mullish B, Thursz M, Manousou P, Yee M . Binge-eating disorder is associated with an unfavorable body mass composition in patients with non-alcoholic fatty liver disease. Int J Eat Disord. 2021; 54(11):2025-2030. DOI: 10.1002/eat.23584. View

Deutsch-Link S, Weinberg E, Bittermann T, McDougal M, Dhariwal A, Jones L . The Stanford Integrated Psychosocial Assessment for Transplant Is Associated With Outcomes Before and After Liver Transplantation. Liver Transpl. 2020; 27(5):652-667. PMC: 9531321. DOI: 10.1002/lt.25975. View

Levenson J, Olbrisch M . Psychosocial evaluation of organ transplant candidates. A comparative survey of process, criteria, and outcomes in heart, liver, and kidney transplantation. Psychosomatics. 1993; 34(4):314-23. DOI: 10.1016/S0033-3182(93)71865-4. View

Borges Da Silva V, Borges Da Silva R, Prudhomme A, Campan P, Azorin J, Belzeaux R . Association between binge eating disorder and psychiatric comorbidity profiles in patients with obesity seeking bariatric surgery. Compr Psychiatry. 2018; 87:79-83. DOI: 10.1016/j.comppsych.2018.09.004. View

Perry J, Deutsch-Link S, Marfeo E, Serper M, Ladin K . Assessing reliability and validity of SIPAT and opportunities for improvement: A single-center cohort study. Liver Transpl. 2023; 30(4):356-366. PMC: 11503466. DOI: 10.1097/LVT.0000000000000299. View

Giammarino A, Qiu H, Bulsara K, Khan S, Jiang Y, Da B . Community Socioeconomic Deprivation Predicts Nonalcoholic Steatohepatitis. Hepatol Commun. 2021; 6(3):550-560. PMC: 8870017. DOI: 10.1002/hep4.1831. View

Sarwer D, Heinberg L . A review of the psychosocial aspects of clinically severe obesity and bariatric surgery. Am Psychol. 2020; 75(2):252-264. PMC: 7027921. DOI: 10.1037/amp0000550. View

10.

Hambleton A, Pepin G, Le A, Maloney D, Touyz S, Maguire S . Psychiatric and medical comorbidities of eating disorders: findings from a rapid review of the literature. J Eat Disord. 2022; 10(1):132. PMC: 9442924. DOI: 10.1186/s40337-022-00654-2. View

11.

Milos G, Spindler A, Hepp U, Schnyder U . Suicide attempts and suicidal ideation: links with psychiatric comorbidity in eating disorder subjects. Gen Hosp Psychiatry. 2004; 26(2):129-35. DOI: 10.1016/j.genhosppsych.2003.10.005. View

12.

Kappus M, Bajaj J . Covert hepatic encephalopathy: not as minimal as you might think. Clin Gastroenterol Hepatol. 2012; 10(11):1208-19. DOI: 10.1016/j.cgh.2012.05.026. View

13.

Punt S, Rhodes A, Ilardi S, Hamilton J . Use of the Stanford Integrative Psychosocial Assessment for Transplant as a Pre-surgical Psychological Evaluation Tool for Bariatric Surgery. J Clin Psychol Med Settings. 2022; 29(4):808-817. DOI: 10.1007/s10880-022-09850-3. View

14.

Kuntz K, Weinland S, Butt Z . Psychosocial Challenges in Solid Organ Transplantation. J Clin Psychol Med Settings. 2015; 22(2-3):122-35. DOI: 10.1007/s10880-015-9435-6. View

15.

Deutsch-Link S, Weinrieb R, Jones L, Solga S, Weinberg E, Serper M . Prior Relapse, Ongoing Alcohol Consumption, and Failure to Engage in Treatment Predict Alcohol Relapse After Liver Transplantation. Dig Dis Sci. 2019; 65(7):2089-2103. DOI: 10.1007/s10620-019-05937-4. View

16.

Blinder B, Cumella E, Sanathara V . Psychiatric comorbidities of female inpatients with eating disorders. Psychosom Med. 2006; 68(3):454-62. DOI: 10.1097/01.psy.0000221254.77675.f5. View

17.

Becker J, Shemesh E, Shenoy A, Posillico A, Knight C, Kim S . The Utility of a Pre-Transplant Psychosocial Evaluation in Predicting Post-Liver Transplant Outcomes. Prog Transplant. 2020; 31(1):4-12. PMC: 7946723. DOI: 10.1177/1526924820978605. View

18.

Cooke B, Magas L, Virgo K, Feinberg B, Adityanjee A, Johnson F . Appendectomy for appendicitis in patients with schizophrenia. Am J Surg. 2006; 193(1):41-8. DOI: 10.1016/j.amjsurg.2006.06.034. View

19.

Ruiz-Casas L, Pedra G, Shaikh A, Franks B, Dhillon H, Fernandes J . Clinical and sociodemographic determinants of disease progression in patients with nonalcoholic steatohepatitis in the United States. Medicine (Baltimore). 2021; 100(50):e28165. PMC: 8677997. DOI: 10.1097/MD.0000000000028165. View

20.

Sharma A, Albhaisi S, Sanyal A . Behavioral health disorders related to nonalcoholic steatohepatitis. Clin Liver Dis (Hoboken). 2022; 20(2):43-47. PMC: 9405487. DOI: 10.1002/cld.1211. View