Journal Article Annotations
2022, 2nd Quarter
Annotations by Sarah R. Andrews, MD and Shehzad K. Niazi, MD, FRCPC, FACLP
This retrospective study described suicide rates for patients who underwent kidney, liver, or pancreas transplants between 1990 and 2019 using UNOS data. The overall incidence of suicide was 0.3% per year—far higher than in the general population. Those patients at highest risk included non-Hispanic white, male sex, and pancreas transplants.
Strength and weaknesses:
This study is the first of its kind to evaluate suicide rates using a large database of transplant patients (over 135,000 patients). This work provides a starting point to develop further studies to better examine suicide rates in the transplant population and relevant risk factors. One weakness was the exclusion of lung and heart patients, who often also have high rates of psychiatric illness.
Suicide is the tenth leading cause of death worldwide, and transplant patients die by suicide at a higher rate than the general population. C-L psychiatrists must inquire about suicide risk for all patients and address that risk accordingly. Transplantation is not a protective factor against suicide.
Daniel and colleagues compared 199 study subjects with alcoholic liver disease (ALD) with 159 subjects who suffered from non-alcohol liver disease. They found that psychosocial status assessed by using the Stanford Integrated Psychosocial Assessment for Transplant (SIPAT) greatly influenced listing for patients with ALC but had only a minor influence on listing for those with non-alcoholic pathology of liver failure.
Strengths & Weakness:
The SIPAT does not distinguish between active and remitted psychosocial problems. Indeed, the developers of SIPAT have advised interpreting SIPAT scores based on active and current issues affecting patients’ score and, by extension, their listing.
The SIPAT was developed to ensure a consistent and standardized psychosocial assessment of transplant candidates. Though SIPAT scores should not be used exclusively to decide who to list for transplant, there is at least one study where a cut-off was used to assess outcomes, and in practice, it appears that SIPAT scores are disproportionately limiting access to transplantation among patients with ALD. ALD patients are likely to experience psychosocial distress and thereby score higher on the SIPAT than do patients with liver failure of other causes. Trained transplant mental health professionals should perform a comprehensive and nuanced psychosocial evaluation on more than one occasion and supplement this assessment with collateral information. In such an evaluation, SIPAT plays a role in identifying areas of concern that a transplant mental health professional can further explore and address. This approach ensures that patients’ candidacy can evolve, and even those not listed initially will have an opportunity to be re-evaluated as their risk profile changes over time with targeted interventions.