# A scoping review of the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) for use with liver transplant candidates

## TL;DR

This review examines how the SIPAT tool is used to assess psychosocial factors in liver transplant candidates, highlighting its potential and limitations.

## Contribution

The study provides a comprehensive scoping review of SIPAT's use in liver transplantation, identifying gaps in evidence and methodological consistency.

## Key findings

- A substantial proportion of liver transplant candidates are classified as having moderate-to-high psychosocial risk using SIPAT.
- Higher SIPAT scores are associated with lower transplant listing likelihood and worse post-transplant outcomes like nonadherence and acute rejection.
- SIPAT scores in alcohol-related liver disease candidates correlate with increased risk of harmful alcohol relapse.

## Abstract

Liver transplantation (LT) is a life-saving treatment for end-stage liver disease, and psychosocial factors significantly influence eligibility, adherence, and outcomes. The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) was developed to standardize psychosocial evaluation across four domains: treatment readiness, social support, psychopathology, and substance use. Despite its growing global adoption, evidence regarding its validity, predictive value, and applicability, specifically in LT, remains fragmented and heterogeneous. This scoping review maps and summarizes the available empirical evidence on SIPAT use in adult LT candidates. It focuses on (1) score distributions (2), psychosocial differences by disease etiology, and (3) associations with listing decisions, post-transplant outcomes, relapse risk, and quality of life.

A systematic search of PubMed, Scopus, and PsycInfo (January 2012–May 2025) identified ten eligible empirical studies, primarily observational in design, with sample sizes ranging from 22 to 2,825 participants. Across studies, a substantial proportion of LT candidates were classified as having moderate-to-high psychosocial risk, frequently exceeding a SIPAT threshold of ≥ 21, although cutoff values varied across studies. Evidence from a limited number of investigations suggests that domains related to treatment readiness and lifestyle/substance use may be particularly affected in LT populations. Studies examining etiological subgroups reported higher SIPAT scores among candidates with alcohol-associated liver disease (ALD) or acute alcoholic hepatitis compared with non-ALD candidates, although findings were not uniform across all studies. Higher total SIPAT scores were associated in several cohorts with lower likelihood of listing and with adverse post-transplant outcomes, including nonadherence and acute rejection. In ALD samples, elevated SIPAT scores were associated with increased risk of harmful alcohol relapse, independent of abstinence duration. Notably, none of the included studies evaluated associations between SIPAT scores and post-transplant quality-of-life outcomes.

Current evidence suggests that the SIPAT is a useful framework for structuring psychosocial assessment in liver transplantation and for identifying potentially modifiable vulnerabilities relevant to listing decisions and selected post-transplant outcomes. However, substantial methodological heterogeneity, inconsistent cutoff thresholds, and limited evidence across some outcome domains, particularly quality of life, constrain comparability and clinical generalizability. Future multicenter, prospective studies are needed to harmonize cutoff values, examine sensitivity to change, and clarify the role of SIPAT in predicting long-term patient-centered outcomes.