Psychosocial Risk Differences Among Veteran Organ Transplant Groups: Rehabilitation Targets to Promote Transplant Listing Outcomes

Research Objectives: To investigate differences in psychosocial risk profiles among Veteran transplant groups during mental health (MH) pre-transplant evaluations to inform rehabilitation targets to promote transplant listing and general outcomes.

Design: Cross-sectional study

Setting: VA Hospital

Participants: 76 male Veterans ranging in age from 29–86 (M=62.9, SD=8.8) undergoing kidney (n=29), liver (n=31), or stem cell (SCT; n=16) transplantation work-up. Sixty-two percent identified as white, 30% Black, 5% Latinx, and 1% American Indian/Alaska Native (1% declined to answer).

Interventions: N/A

Main Outcome Measures: Psychosocial risk assessed using the Stanford Integrated Psychosocial Assessment for Transplant (SIPAT) to derive subscales of Patient’s Readiness (PR), Social Support, Psychological Suitability and Psychopathology, and Lifestyle and Effect of Substance Use (LESU), with higher scores signifying greater psychosocial risk.

Results: Four ANOVA models were run (SIPAT subscale=dependent variable; transplant type=independent variable). Significant effects were found for PR, F(2, 73) = 3.98, p = .023, and LESU, F(2, 73) = 6.18, p = .003. Nonparametric bootstrapped t-tests using 10,000 resamples revealed higher mean scores for liver compared to kidney and SCT groups for PR (95% CI: 0.53 – 3.73, p = .009; 95% CI: 0.27 – 3.84, p = .025, respectively) as well as LESU (95% CI: 1.81 – 6.73, p < .001; 95% CI: 0.28 – 5.88, p = .030, respectively). Confidence intervals for differences among SCT and kidney groups contained zero (PR 95% CI: -1.45 – 1.58, LESU 95% CI: -1.85 – 1.98).

Conclusions: Patients from different transplant populations may require different rehabilitation/intervention needs to ensure potential listing and general success. Specifically, liver transplant patients may benefit from additional education on the transplant process and encouraging changes in substance use/lifestyle factors. Future research should investigate differences in psychosocial risk as well as the predictive validity of the SIPAT for long-term treatment outcomes (i.e., transplantation) across transplant groups.

Author(s) Disclosures: N/A