Identifying organ-specific psychosocial vulnerabilities in transplant candidates: Evidence from a SIPAT evaluation

Psychosocial factors play a critical role in transplant candidacy, adherence, and clinical outcomes. The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) provides a multidimensional framework for psychosocial evaluation; however, comparative evidence across different transplant indications and its associations with symptom and quality-of-life measures remain limited. This study aimed to characterize psychosocial risk profiles across transplant indications using the SIPAT and to examine their associations with sociodemographic, clinical, and psychosocial variables in routine clinical practice. We conducted a cross-sectional observational study involving 176 adult transplant candidates (liver, kidney, lung, heart, bone marrow). Psychosocial functioning was assessed using the SIPAT alongside measures of psychological symptoms, substance use, and quality of life. Group comparisons and hierarchical regression analyses were performed to examine associations between SIPAT scores and aforementioned variables. The median total SIPAT score was 16.0 (IQR 10.0–22.5); 28.4% of candidates were classified as high psychosocial risk, most frequently among liver transplant candidates (44.1%). In hierarchical linear regression, higher alcohol use (β = 0.509, p < 0.001), greater depressive symptom severity (β = 0.226, p = 0.033), and lower education (β = −0.182, p = 0.003) independently predicted higher SIPAT scores. In hierarchical logistic regression, alcohol use (OR = 2.20, p < 0.001) and lower education (OR = 0.75, p = 0.007) independently predicted high psychosocial risk. Domain-level SIPAT assessment provides a structured and clinically informative approach to identifying psychosocial vulnerability across transplant indications, highlighting alcohol use and lower education as key targets for pre-transplant evaluation and support. • Liver transplant candidates showed the highest proportion of high psychosocial risk (SIPAT ≥21) among transplant groups. • Higher SIPAT scores were associated with greater depressive symptom severity, higher alcohol use, lower educational attainment, and poorer self-reported quality of life. • Liver and kidney transplant candidates displayed the most robust organ-specific associations between SIPAT scores and psychosocial and clinical indicators. • Alcohol use and lower educational attainment independently predicted high psychosocial risk in multivariable logistic regression analyses.