Higher-risk SIPAT score predicts increased risk of long-term mortality in orthotopic heart transplant recipients

Revanth Kosaraju; Elizabeth Vandenbogaart; Erin Core; Julie Creaser; Nancy Livingston; Melissa Moore; Megan Kamath; Mario Deng

doi:10.1016/j.ijcard.2023.131360

Higher-risk SIPAT score predicts increased risk of long-term mortality in orthotopic heart transplant recipients

Int J Cardiol. 2023 Dec 15:393:131360. doi: 10.1016/j.ijcard.2023.131360. Epub 2023 Sep 12.

Authors

Revanth Kosaraju¹, Elizabeth Vandenbogaart², Erin Core², Julie Creaser², Nancy Livingston², Melissa Moore², Megan Kamath², Mario Deng²

Affiliations

¹ Department of Medicine, Division of Cardiology, University of California Los Angeles, Los Angeles, CA 90095, United States of America. Electronic address: rkosaraju@mednet.ucla.edu.
² Department of Medicine, Division of Cardiology, University of California Los Angeles, Los Angeles, CA 90095, United States of America.

PMID: 37709206
DOI: 10.1016/j.ijcard.2023.131360

Abstract

Background: Orthotopic heart transplantation (OHT) improves survival in eligible patients. Organ scarcity necessitates extensive clinical and psychosocial evaluations before listing. The Stanford Integrated Psychosocial Assessment for Transplant (SIPAT) predicts risk for poor psychosocial outcomes and morbidity in the first year post-transplant, yet it is unknown whether it predicts long-term outcomes.

Methods: Blinded examiners obtained data from a retrospective cohort of 51 OHT recipients from a high-volume center. Patients with "Excellent" or "Good" SIPAT score indicating low psychosocial risk for transplant (E/G) were compared with those who met "Minimum Acceptable Criteria" or were "High Risk" (MAC/HR). Associations were examined between SIPAT group and outcomes.

Results: MAC/HR versus E/G recipients had significantly reduced survival in the 10 years post-OHT (mean 6.7 vs 8.8 years, p = 0.027; 55% vs 82% survival proportions, p = 0.037). MAC/HR patients were more likely to live in a county with greater income inequality (p = 0.025) and have psychiatric history pre-OHT (p = 0.046). Both groups had otherwise similar demographics and medical history. A lower proportion of MAC/HR patients adhered to medications post-OHT and a greater proportion had psychiatric illness, though differences were not significant.

Conclusions: Higher-risk SIPAT scores predict reduced long-term survival post-OHT. Further efforts are crucial to improve outcomes in higher-risk patients.

Keywords: Equity; Orthotopic heart transplantation (OHT); Psychosocial; Survival.