Associations Between Substance-Related Concerns and Psychosocial Burden Outside the SIPAT Substance-Use Domain in Lung Transplant Candidates: A Retrospective Single-Center Study

Background: Psychosocial assessment is an important component of lung transplant evaluation. Substance-related concerns may coexist with broader psychosocial vulnerabilities, but this relationship is difficult to evaluate when substance-use indicators and psychosocial scores contain overlapping information. We aimed to characterize psychosocial risk in lung transplant candidates and examine whether alcohol-, nicotine-, and illicit drug-related concerns were associated with psychosocial burden outside the SIPAT substance-use domain. Methods: We retrospectively analyzed 491 adult lung transplant candidates admitted for their first inpatient evaluation at the University Clinical Center in Gdańsk, Poland, between December 2021 and November 2025. All patients underwent routine psychosocial consultation, including the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT), completed using a locally developed Polish translation. To avoid conceptual and statistical overlap with substance-related indicators derived from Domain D, we calculated a non-substance psychosocial score as the sum of Domains A, B, and C. Three logistic regression models adjusted for age and sex examined associations with alcohol-, nicotine-, and illicit drug-related concerns. Holm correction was applied across the three primary tests. Results: The mean age was 57.2 years (SD = 10.7), and 40.5% of participants were women. Most candidates were classified as excellent or good (89.4%). Alcohol-, nicotine-, and illicit drug-related concerns were documented in 39.5%, 43.8%, and 13.4% of candidates, respectively. In complete-case models (N = 489), each five-point increase in the non-substance psychosocial score was associated with higher odds of alcohol-related concerns (OR = 1.26, 95% CI 1.07–1.48, p = 0.006; Holm-adjusted p = 0.017) and nicotine-related concerns (OR = 1.22, 95% CI 1.04–1.43, p = 0.014; Holm-adjusted p = 0.028). No significant association was observed for illicit drug-related concerns (OR = 0.81, 95% CI 0.62–1.02, p = 0.090). Male sex was associated with alcohol-related concerns (OR = 2.16, 95% CI 1.47–3.19, p < 0.001). Conclusions: Alcohol- and nicotine-related concerns were associated with broader psychosocial burden extending beyond the SIPAT substance-use domain. These findings suggest that substance-related concerns may coexist with difficulties in readiness, social support, or psychological functioning rather than representing isolated behavioral findings. Because this study was cross-sectional and used a non-validated local translation, the results should not be interpreted as evidence of psychometric or predictive validity.