About

Robert M. Weinrieb, M.D., is a Professor of Psychiatry at the Hospital of the University of Pennsylvania and serves as an Attending Physician and Chief Psychiatric Consultant to the Penn Transplant Institute at the University of Pennsylvania. He is also the Program Director for the Consultation-Liaison Psychiatry (Psychosomatic Medicine) Fellowship, which is accredited by the ACGME. Dr. Weinrieb founded the Penn Medicine Total Recovery Outpatient Program for Liver Transplant Patients with Alcohol Use Disorders at Penn Presbyterian Hospital and has been involved in planning and providing clinical support for the Integrated Liver Transplant Engagement And Recovery Network (ILEARN), a co-located, integrated Alcohol Use Disorders clinic for Hepatology and Psychiatry at the Hospital of the University of Pennsylvania. His educational background includes a B.A. in Psychology from the State University of New York at Buffalo and an M.D. from the same institution's School of Medicine. His research and clinical work focus on substance use disorders, particularly in the context of liver transplantation, and he has contributed to the literature on psychosocial evaluation, treatment of alcohol use disorder in transplant recipients, and disparities in transplant evaluation.

Research topics

• Medicine
• Internal medicine
• Psychiatry
• Demography
• Gerontology
• Intensive care medicine
• Emergency medicine
• Nursing
• Surgery
• Pathology
• Psychology
• Family medicine

Selected publications

• 109. Memantine Makes the Difference: The Role of Memantine in Managing Post-Transplant Neuropsychiatric Sequelae

  Journal of the Academy of Consultation-Liaison Psychiatry · 2025-11-01

  articleSenior author
  PublisherDOI

• Program Evaluation of Pharmacist-Performed Medication Adherence Assessments in Candidates for Living Donor Kidney Transplant

  Progress in Transplantation · 2024

  • Medicine
  • Family medicine
  • Emergency medicine

  Over 40% of candidates reported characteristics concerning medication nonadherence despite over 90% reporting adherence strategies used. Medication adherence assessments can assist with identification of medication nonadherence and education individualization.

  PublisherDOI

• A Tailored Virtual Program for Alcohol Use Disorder Treatment Among Liver Transplant Candidates and Recipients Is Feasible and Associated With Lower Post‐Transplant Relapse

  Clinical Transplantation · 2024-06-28 · 11 citations

  articleOpen access

  BACKGROUND: Alcohol-associated liver disease (ALD) is a leading indication for liver transplant (LT) in the United States. Rates of early liver transplant (ELT) with less than 6 months of sobriety have increased substantially. Patients who receive ELT commonly have alcohol-associated hepatitis (AH) and are often too ill to complete an intensive outpatient program (IOP) for alcohol use disorder (AUD) prior to LT. ELT recipients feel alienated from traditional IOPs. METHODS: We implemented Total Recovery-LT, a tailored virtual outpatient IOP specific for patients under evaluation or waitlisted for LT who were too ill to attend community-based alcohol treatment programs. The 12-week program consisted of weekly group and individual counseling delivered by a master's level Certified Addiction Counselor trained in the basics of LT. Treatment consisted of 12-Step Facilitation, Motivational Interviewing, and Cognitive Behavioral Therapy. We report on program design, implementation, feasibility and early outcomes. RESULTS: From March 2021 to September 2022, 42 patients (36% female, 23 in LT evaluation, 19 post-transplant) enrolled across five cohorts with 76% (32/42) completing the program. Alcohol relapse was more common among noncompleters versus those who completed the program (8/10, 80% vs. 7/32, 22%, p = 0.002). History of trauma or post-traumatic stress symptoms were associated with lower likelihood of completion. Patients' desire for continued engagement after completion led to the creation of a monthly alumni group. CONCLUSIONS: Our integrated IOP model for patients with high-risk AUD in LT evaluation or post-transplant is well-received by patients and could be considered a model for LT programs.

  PublisherOA PDFDOI

• Therapy of alcohol use disorder in liver transplant recipients

  Liver Transplantation · 2024-11-29

  article1st authorCorresponding
  PublisherDOI

• Racial and ethnic disparities in psychosocial evaluation and liver transplant waitlisting

  American Journal of Transplantation · 2023 · 31 citations

  • Medicine
  • Demography
  • Gerontology
  PublisherOA PDFDOI

• Through the Lens of Our Patients – Disparities in Organ Transplant

  Journal of the Academy of Consultation-Liaison Psychiatry · 2023-11-01

  article
  PublisherDOI

• The Integrated Liver Transplant Engagement and Recovery Network (ILEARN) Project for Post-Liver Transplant Management of Alcohol Use Disorders

  Journal of the Academy of Consultation-Liaison Psychiatry · 2023-11-01 · 1 citations

  articleSenior author
  PublisherDOI

• Substance use screening in transplant populations: Recommendations from a consensus workgroup

  Transplantation Reviews · 2022-04-01 · 8 citations

  review
  PublisherDOI

• The Role of Psychosocial Screening Tools in the Evaluation of Transplantation Patients With Alcohol‐Related Liver Disease

  Liver Transplantation · 2022-03-07 · 3 citations

  letter1st authorCorresponding

  Potential conflict of interest: Nothing to report. SEE ARTICLE ON PAGE 936 Psychosocial assessment is a well‐recognized component in addition to the medical and surgical aspects of a comprehensive transplant candidate evaluation. The role of a transplant psychosocial evaluation is to assess a candidate’s social, behavioral, psychiatric, and cognitive functioning with the intent of identifying areas that may represent potential risks to optimal transplant outcomes. If areas of deficiency are identified through the psychosocial evaluation, many transplant programs allow potential candidates an opportunity to be reassessed once they begin to address or remediate these problem areas. Thus, a key aspect of the psychosocial assessment is to assist in the development and implementation of a psychosocial treatment plan to mitigate risk and minimize preventable problems with the goal of optimizing posttransplant psychiatric and medical outcomes. Standardized transplant‐specific assessment tools are used by some transplant psychosocial assessors in addition to a clinical interview to maintain consistency and to ensure that all relevant areas are covered. One such assessment tool is the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT). The SIPAT developers recognized a lack of standardization in the psychosocial selection criteria as well as the actual psychosocial assessment at their own institution and within the published literature.(1) They reasoned that such a tool could standardize the evaluation, ensuring that all content domains were assessed and accurately summarized in addition to improving equity for all transplant candidates. Notably they envisioned the SIPAT as a tool to identify potential candidates at risk for less‐than‐optimal outcomes after transplant to focus the assessors on areas needing improvement and to develop interventions directed at increasing a patient’s likelihood of being accepted and placed on the waiting list.(1) The authors did not consider the SIPAT a standalone assessment and recommended a psychosocial assessor use collateral sources of information to supplement and verify the information obtained from the patient interview. Moreover, given the limited information on the validity of such metrics,(2) the use of the SIPAT or other psychosocial tools to generate a score or rating of a patient’s suitability for transplant is not recommended by the SIPAT creators(1) or transplant society guidelines.(2) Rather, the SIPAT developers recommended using the SIPAT to complement the psychosocial evaluation process and not be used as the sole determinant of eligibility for transplantation.(1) In the article by Daniel et al.(3), SIPAT scores were used to examine differences between liver transplantation (LT) candidates with alcohol‐related liver disease (ALD) compared with candidates without ALD. Not unexpectedly, based on their alcohol and/or substance use histories, LT candidates with ALD had higher SIPAT scores, which is indicative of greater psychosocial risk. The authors found that compared with the non‐ALD cohort, patients with ALD had higher scores on all subscales of the SIPAT, including substance and alcohol use, other mental health disorders, social support, and psychosocial stability. Individuals with alcohol use disorders have higher rates of comorbid substance use, depression, anxiety, and other mental health disorders,(4) which could explain the difference in the SIPAT scores of their candidates with ALD compared with non‐ALD LT candidates. Daniel et al.(3) also hypothesized that only patients with ALD with low SIPAT scores would be selected but found that among candidates with ALD selected for listing, SIPAT scores were significantly higher than non‐ALD candidates. They did not provide an interpretation of this finding; however, it is important to recognize that SIPAT scores do not distinguish whether a patient’s psychosocial issues are active or remitted. Indeed, even patients whose psychiatric disorders or unhealthy behaviors are in stable remission will contribute to an unfavorable SIPAT score. What is more pertinent to the psychosocial evaluation and ultimately transplant listing are existing disorders and issues that require intervention in preparation for transplant. As recommended by its developers, scores from the SIPAT must be interpreted through the lens of risk factors that are active and must be satisfactorily addressed before listing.(1) The authors of a prior study using SIPAT cutoff scores rather than liver disease diagnosis to predict outcomes suggested that SIPAT scores could offer insights into higher risk recipients who require additional support before and after transplantation.(5) This study demonstrated that patients with cutoff scores ≥21 were less likely to be listed and if listed and received transplants resulted in a greater likelihood of immunosuppression medication nonadherence.(5) Moreover, in addition to the total SIPAT score being informative, a poorer score on the subscale of readiness for transplant was associated with a higher likelihood of graft rejection.(5) The focus on candidates with ALD in the paper by Daniel et al.(3) highlights the potential psychosocial challenges these candidates can create for transplant teams. Although SIPAT scores can identify those at higher psychosocial risk and perhaps even predict those at risk for poorer posttransplant outcomes, what strategies can be employed to reduce these risks for patients with ALD? There are many effective therapies for alcohol use, substance use, and mental health disorders that can be implemented prior to and following transplant. Addiction rehabilitation is a key therapy to reduce relapse risk. Although patients with ALD are expected to maintain abstinence, many patients with ALD, especially those with short sobriety, have difficulty maintaining abstinence without professional help. This is especially true for patients who receive transplants for alcohol associated hepatitis who typically have very short pretransplant sobriety. All patients with ALD should receive close posttransplant follow‐up with addiction and mental health providers at regularly scheduled intervals to identify and treat psychiatric disorders and relapses. For patients with ALD, in addition to addiction counseling, pharmacotherapy may be beneficial. Naltrexone and other medications used for the treatment of alcohol or substance use should be considered. Although randomized controlled trials evaluating the safety and effectiveness of medications to treat alcohol or substance use disorders have not been published in patients with ALD, there are convincing data about the safety and effectiveness of certain anticraving medications in the non‐ALD population that can be applicable to patients with ALD.(6) In addition to treatment, monitoring for abstinence with random biochemical screening (eg, phosphatidylethanol and urine toxicology) should be conducted prior to and following transplant. Screening for other mental health symptoms using standardized screening tools may also be warranted for those at risk of other mental health disorders. Treatment delivery can be improved by integrated care models staffed by mental health and addiction experts who are colocated in the same physical space as the LT team. Clinics providing such support may help patients overcome barriers to accessing addiction and mental health treatment and may also provide better collaborative care,(7) Finally, telepsychiatry can improve access to care for patients with ALD with mental health and substance use disorders. This may be an essential tool to remove obstacles to treatment for patients who struggle with travel to transplant programs and/or have limited resources. Telepsychiatry can also provide transplant teams with a less‐expensive treatment option that can improve show rates for patients seeking mental health and addiction services. In summary, we concur with Daniel et al.(3), who advocate for a nuanced psychosocial evaluation performed by trained transplant mental health professionals. Pretransplant patients should be individually evaluated and if possible, interviewed at more than 1 point in time. Such an evaluation should be supplemented by collateral information. Although most programs make decisions about listing using a combination of sources of information, the potential for bias exists if teams rely too heavily on summary scores from assessment tools. Rather, psychosocial tools such as SIPAT should serve as a guide to identify a potential LT patient’s psychosocial challenges. Thus, information derived from psychosocial tools can be used to develop a treatment plan with reasonable, measurable goals so ineligible transplant candidates can be provided with an opportunity to be reevaluated for transplant consideration in the future.

  PublisherDOI

• Psychiatric Evaluation of the Liver Transplant Candidate with Alcohol-Associated Hepatitis

  2022-01-01 · 2 citations

  book-chapter1st authorCorresponding
  PublisherDOI

Recent grants

• NIH Grant R01AA012299

  NIH · $2.0M · 2005

• NIH Grant K20AA000197

  NIH · $808k · 2000

Frequent coauthors

• John W. Barnhill

  82 shared

• Thomas N. Wise

  George Washington University

  82 shared

• Elena del Busto

  82 shared

• Stephen M. Saravay

  Evanston Hospital

  82 shared

• Theodore A. Stern

  The University of Texas Southwestern Medical Center

  82 shared

• Roger G. Kathol

  82 shared

• Steven Epstein

  University of California, Davis

  82 shared

• Philip R. Muskin

  82 shared