Beyond Gatekeeping: SIPAT as a Guide to Psychosocial Prehabilitation in a Single-Center Cohort of Lung Transplant Candidates

Background: Psychosocial assessment is central to lung transplant evaluation. Structured tools such as the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) can be used either to support exclusionary decisions or to guide psychosocial prehabilitation by identifying modifiable targets for intervention. We examined how SIPAT functions in a program that explicitly prioritizes remediation of modifiable psychosocial risks. Methods: We conducted a retrospective observational cohort study of consecutive adult lung transplant candidates evaluated at a single center in Poland between December 2021 and November 2025. Psychosocial risk was assessed using SIPAT (locally translated), including total and domain scores, candidate categories, and binary indicators of clinically relevant alcohol, illicit substance and nicotine related risk. The primary endpoint was a pragmatic program outcome, defined as ever being listed (including transplanted) versus not listed. Analyses focused on describing psychosocial risk profiles and their relationship to the program pathway rather than on building a predictive model of listing decisions. Results: In 491 candidates (mean age 57.2 years; 40.5% women), psychosocial burden was generally low (mean total SIPAT 12.4, SD 6.8) and most patients were rated as excellent or good candidates. SIPAT total, domain scores and candidate categories were not meaningfully associated with ever being listed. Nicotine related risk was more frequent among listed candidates, consistent with a clinical strategy in which smoking histories in predominantly COPD and emphysema patients trigger intensive cessation support rather than automatic exclusion. Cluster analyses identified a smaller high-risk subgroup, and ROC analyses showed modest discrimination for alcohol and nicotine related risk, supporting SIPAT as a structured needs assessment. Conclusions: In this prehabilitation oriented program, SIPAT did not operate as a binary gatekeeping instrument for listing. Instead, it primarily served to identify modifiable psychosocial targets that trigger tailored support. These findings support using SIPAT as a structured roadmap for psychosocial prehabilitation rather than a stand-alone exclusion tool.