title: Impact of Concurrent Non-IBD Immunological Diseases on the Outcome of Primary Sclerosing Cholangitis.
abstract: BACKGROUND
  The association between primary sclerosing cholangitis (PSC) and underlying inflammatory bowel disease (IBD) is well established. There are scant data on the association between non-IBD immunological diseases (NID) and PSC outcomes. Our objective was to investigate the impact of NID on the clinical outcomes in patients with PSC.
  
  
  METHODS
  We included 287 patients with PSC from 1985 to 2013 from our tertiary care data registry. Univariate and multivariate analyses were performed to assess the risk factors for liver transplantation.
  
  
  RESULTS
  Of the 287 patients with PSC, 38 (13.2%) patients had at least 1 concomitant immunological disease other than IBD; 241 patients (84.0%) had concurrent IBD. The most frequent NIDs were autoimmune thyroiditis, autoimmune hepatitis, and rheumatoid arthritis. The median follow-up time did not differ significantly between PSC patients with and without NID (10.5 years versus 7.0 years, P = 0.04). We did not find significant difference in the median time from PSC diagnosis to liver transplantation between PSC patients with and without NID (5.2 versus 6.3 years, P = 0.74). In the subgroup analysis, there was no significant difference in the median time from PSC diagnosis to liver transplantation between the PSC-only group, PSC with IBD group, and PSC with NID group (5.4 versus 6.4 versus 5.2 years, P = 0.22).
  
  
  CONCLUSIONS
  The association of NID in patients with PSC did not seem to affect the need for liver transplantation or transplantation-free survival. The findings suggest that the increased load of autoimmunity, including the presence of IBD or NID, has a minimum impact on the disease outcome of PSC.
authors.affiliation: *Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio; †Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio; and ‡Center for Interventional Endoscopy, Florida Hospital Institute for Minimally Invasive Therapy, Orlando, Florida.
authors.forename: Ramprasad
authors.initials: R
authors.lastname: Jegadeesan
authors.forename: Udayakumar
authors.initials: U
authors.lastname: Navaneethan
authors.forename: Shishira
authors.initials: S
authors.lastname: Bharadwaj
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Hammel
authors.forename: Madhusudhan R
authors.initials: MR
authors.lastname: Sanaka
authors.forename: Bo
authors.initials: B
authors.lastname: Shen
mesh_terms: D000328:Adult; D015209:Cholangitis, Sclerosing / Q000175:diagnosis / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007154:Immune System Diseases / Q000503:physiopathology*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis