title: Progressive primary sclerosing cholangitis requiring liver transplantation is associated with reduced need for colectomy in patients with ulcerative colitis.
abstract: OBJECTIVE
  We investigated the association between the severity of primary sclerosing cholangitis (PSC) and clinical outcomes of patients with ulcerative colitis (UC) on the basis of need for colectomy.
  
  
  METHODS
  We analyzed data from 167 patients with PSC and UC who were followed from 1985 to 2011. Patients with PSC and UC were divided into groups that received orthotopic liver transplantation (OLT) (n = 86) or did not (non-OLT, n = 81). Clinical and demographic variables were obtained, and patients were followed until they received OLT or the date of their last clinical visit.
  
  
  RESULTS
  The OLT group had significantly more subjects with less severe symptoms of UC (59, 68.6%) than the non-OLT group (12, 14.8%; P < .001). The subjects in the OLT group had a median of 0 UC flares compared with 3 in the non-OLT group (P < .001); fewer subjects in the OLT group required use of azathioprine or mercaptopurine (1, 1.2%), compared with the non-OLT group (14, 17.3%; P = .006). More subjects in the non-OLT group required colectomies (61, 75.3%) than in the OLT group (23, 26.7%; P < .001). On the basis of Cox regression analysis, OLT for PSC independently reduces the need for colectomy (hazard ratio [HR], 0.43; 95% confidence interval [CI], 0.25-0.75; P = .003), as does a high Mayo risk score at diagnosis (HR, 0.52; 95% CI, 0.37-0.72; P < .001). Development of colon neoplasia increased the risk for colectomy (HR, 2.47; 95% CI, 1.63-3.75; P < .001).
  
  
  CONCLUSIONS
  Severe progressive PSC that requires liver transplantation appears to reduce the disease activity of UC and the need for colectomy.
authors.affiliation: Department of Gastroenterology, Digestive Disease Institute, The Cleveland Clinic, Cleveland, Ohio 44195, USA. navaneu@ccf.org
authors.forename: Udayakumar
authors.initials: U
authors.lastname: Navaneethan
authors.forename: Preethi G K
authors.initials: PG
authors.lastname: Venkatesh
authors.forename: Saurabh
authors.initials: S
authors.lastname: Mukewar
authors.forename: Bret A
authors.initials: BA
authors.lastname: Lashner
authors.forename: Feza H
authors.initials: FH
authors.lastname: Remzi
authors.forename: Arthur J
authors.initials: AJ
authors.lastname: McCullough
authors.forename: Ravi P
authors.initials: RP
authors.lastname: Kiran
authors.forename: Bo
authors.initials: B
authors.lastname: Shen
authors.forename: John J
authors.initials: JJ
authors.lastname: Fung
mesh_terms: D000328:Adult; D000368:Aged; D015209:Cholangitis, Sclerosing / Q000150:complications* / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D003082:Colectomy / Q000706:statistics & numerical data*; D003093:Colitis, Ulcerative / Q000150:complications* / Q000473:pathology; D005260:Female; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome