Prior Relapse, Ongoing Alcohol Consumption, and Failure to Engage in Treatment Predict Alcohol Relapse After Liver Transplantation

Deutsch‐Link, Sasha; Weinrieb, Robert M.; Jones, Lauren; Solga, Steven F.; Weinberg, Ethan M.; Serper, Marina

doi:10.1007/s10620-019-05937-4

Cited by 42 publications

(49 citation statements)

References 40 publications

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“…In the patients who progressed to transplantation, a higher score in the readiness domain was associated with nonadherence with immunosuppression as measured by “tacrolimus coefficient of variation.” They did not report on post‐LT alcohol use, but the same authors had previously reported that higher SIPAT scores before LT were associated with more frequent alcohol relapse after LT in patients with ALD. ( 16 ) The recent study from the University of Pennsylvania and our study have some obvious differences. First, 28% of the patients in the University of Pennsylvania cohort had ALD in contrast to 58% in our cohort.…”

Section: Discussioncontrasting

confidence: 61%

Psychosocial Assessment Rather Than Severity of Liver Failure Dominates Selection for Liver Transplantation in Patients With Alcohol‐Related Liver Disease

et al. 2021

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The Stanford Integrated Psychosocial Assessment for Transplant (SIPAT) is a validated interview tool to assess psychosocial well‐being in candidates for solid organ transplants, with higher scores indicating greater vulnerability. We hypothesized that patients with alcohol‐related liver disease (ALD) undergoing liver transplantation (LT) evaluation would have higher SIPAT scores than candidates with non‐ALD, but that only patients with ALD who have low scores would be selected. We analyzed retrospectively consecutive adults undergoing LT evaluation from June 2018 to December 2019. Comparisons between patients with ALD and patients with non‐ALD were made using the nonparametric Wilcoxon rank sum test plus a multivariate analysis to determine independent predictors for approval. In the study cohort of 358 patients, there were 199 (56%) patients with ALD with a mean age of 55 years, and 133 (67%) were men. There were 159 (44%) patients with non‐ALD with a mean age of 57 years, and 95 (60%) were men. Mean Model for End‐Stage Liver Disease–sodium scores were similar for selected versus not selected patients with ALD (25 versus 25.6) and selected versus not selected patients with non‐ALD (18.3 versus 17.4), although the ALD group had substantially higher Model for End‐Stage Liver Disease scores. Patients with ALD had higher mean SIPAT composite and individual domain scores compared with their non‐ALD counterparts. SIPAT scores were not affected by age or sex. Proportionately more candidates with non‐ALD were selected compared to candidates with ALD (68% versus 42%; P < 0.001; odds ratio for approval of non‐ALD versus ALD, 2.9; 95% confidence interval, 1.8‐4.7; P < 0.001). Composite SIPAT scores were lower in the selected versus nonselected in both ALD and non‐ALD groups, although the SIPAT scores were significantly higher in selected patients with ALD (median, 39) than selected patients with non‐ALD (median, 23; P = 0.001). Psychosocial assessment has a greater influence than acuity of liver failure on the selection of patients with ALD for LT listing, whereas psychosocial assessment has a minor influence on the selection of non‐ALD candidates.

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Section: Discussioncontrasting

confidence: 61%

Psychosocial Assessment Rather Than Severity of Liver Failure Dominates Selection for Liver Transplantation in Patients With Alcohol‐Related Liver Disease

et al. 2021

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“…One prior study with a smaller sample size demonstrated a relationship between total SIPAT score and IS nonadherence as measured by the tacrolimus CoV, but did not examine specific SIPAT domain scores. (7) Our results did not show that the SIPAT social support domain was significantly associated with medication nonadherence, which may reflect differences in social support measures because no other studies have studied SIPAT domains specifically.…”

Section: Original Article | 663contrasting

confidence: 88%

The Stanford Integrated Psychosocial Assessment for Transplant Is Associated With Outcomes Before and After Liver Transplantation

et al. 2021

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The Stanford Integrated Psychosocial Assessment for Transplant (SIPAT) is a standardized psychosocial evaluation tool used in liver transplantation (LT) evaluation. We assessed the impact of the SIPAT score and subdomains on transplant waitlisting decisions and post-LT outcomes including immunosuppression (IS) nonadherence, biopsy-proven rejection, andmortality/ graft failure. We conducted a single-center observational cohort study of 1430 patients evaluated for LT. Patients were divided in 2 groups based on a SIPAT cutoff score of <21 or ≥21 (higher SIPAT scores indicate higher psychosocial risk). Regression models assessed relationships between total SIPAT score and domain scores and waitlisting decisions, IS nonadherence, allograft rejection, and death/graft failure. Elevated total SIPAT and SIPAT domain scores were associated not being added to the waitlist (total SIPAT core ≥21 adjusted odds ratio [aOR], 1.78 [95% confidence interval, CI, 1.36-2.33]; readiness score ≥5 aOR, 2.01 [95% CI, 1.36-2.76]; social support score ≥4aOR, 1.50 [95% CI, 1.15-1.94]; psychopathology score ≥7 aOR, 1.45 [95% CI, 1.07-1.94]; lifestyle/substance abuse score ≥12 aOR, 1.72 [95%CI, 1.23-2.39]) and were more likely to experience IS nonadherence as measured by the tacrolimus coefficient of variation (CoV) (total SIPAT score ≥21 aOR, 2.92 [95% CI, 1.69-5.03]; readiness score ≥5 aOR, 3.26 [95% CI, 1.63-6.52]; psychopathology score ≥7 aOR, 1.88 [95% CI, 1.00-3.50]; lifestyle substance abuse score ≥12 aOR, 3.03 [95% CI, 1.56-5.86]). SIPAT readinessscore ≥5 was associated with biopsyproven allograft rejection (aOR, 2.66; 95% CI, 1.20-5.91). The SIPAT score was independently associated with LT listing decisions and IS nonadherence, and the readiness domain was associated with the risk of allograft rejection. These findings offer insights into higher risk recipients who require additional support before and aftertransplantation.

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“…Our AI model appears to have superior positive predictive value (82% in external validation) versus existing scoring systems (0%–25%), and could eventually replace these other existing scoring systems if the enhanced performance metrics are validated prospectively 7–11 . Many ALD prediction studies focus on AUC, but our study highlights that this may not be the most appropriate metric, particularly in ALD where alcohol relapse is a relatively infrequent, but important outcome.…”

Section: Discussionmentioning

confidence: 88%

“…Scoring systems studied in early LT for AH which combine multiple psychosocial variables, including the Sustained Alcohol Use after Liver Transplant (SALT), Hopkins Psychosocial Scale (HPSS), High‐Risk Alcohol Relapse (HRAR), and Stanford Integrated Psychosocial Assessment for Transplant (SIPAT) scores each have area under curve (AUC) values ranging 0.60–0.75 for post‐LT harmful alcohol use. These reflect high negative predictive value as these models have poor positive predictive value (0–0.25) limiting clinical utility 7–11 . Most other models have focused on the broader LT for ALD population, and have not been specifically evaluated in LT candidates with short duration of abstinence.…”

Section: Introductionmentioning

confidence: 99%

Artificial intelligence to identify harmful alcohol use after early liver transplant for alcohol-associated hepatitis

Lee

Roth

Rao

et al. 2022

American Journal of Transplantation

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Early liver transplantation (LT) for alcohol-associated hepatitis (AH) is the fastest growing indication for LT, but prediction of harmful alcohol use post-LT remains limited. Among 10 ACCELERATE-AH centers, we examined psychosocial evaluations from consecutive LT recipients for AH from 2006 to 2017. A multidisciplinary panel used content analysis to develop a maximal list of psychosocial variables. We developed an artificial intelligence model to predict post-LT harmful alcohol use. The cohort included training (N = 91 among 8 centers) and external validation (N = 25 among 2 | 1835 AJT LEE Et aL.

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Prior Relapse, Ongoing Alcohol Consumption, and Failure to Engage in Treatment Predict Alcohol Relapse After Liver Transplantation

Cited by 42 publications

References 40 publications

Psychosocial Assessment Rather Than Severity of Liver Failure Dominates Selection for Liver Transplantation in Patients With Alcohol‐Related Liver Disease

Psychosocial Assessment Rather Than Severity of Liver Failure Dominates Selection for Liver Transplantation in Patients With Alcohol‐Related Liver Disease

The Stanford Integrated Psychosocial Assessment for Transplant Is Associated With Outcomes Before and After Liver Transplantation

Artificial intelligence to identify harmful alcohol use after early liver transplant for alcohol-associated hepatitis

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