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Sci Rep. 2018 May 1;8(1):6825. doi: 10.1038/s41598-018-24060-4.

In-patient outcomes of Hematopoietic Stem Cell Transplantation in Patients with Immune Mediated Inflammatory Diseases: A Nationwide Study.

Author information

1
Division of Hematology and Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
2
Department of Internal Medicine, John H Stroger, Jr. Hospital of Cook County, Chicago, Illinois, USA.
3
Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio, USA.
4
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
5
Division of Gastroenterology, Department of Medicine Olive View-UCLA Medical Center, Sylmar, CA, United States.
6
Division of Gastroenterology and Liver Disease, University Hospitals, Case Western Reserve University, Cleveland, Ohio, USA.
7
Division of Gastroenterology and Liver Disease, University Hospitals, Case Western Reserve University, Cleveland, Ohio, USA. maneesh.dave@case.edu.

Abstract

The impact of underlying immune-mediated inflammatory diseases (IMID) in patients undergoing hematopoietic stem cell transplant (HSCT) is unclear. Hematopoietic cell transplantation co-morbidity index (HCT-CI) is gaining acceptance as a reliable clinical method to score pre-transplant co-morbidities. Higher HCT-CI from a co-morbid IMID implies higher NRM. However, HCT-CI integrates many IMIDs with different pathogenesis and treatment together which may lead to spurious results. We performed a cross-sectional study using Nationwide Inpatient Sample dataset from 1998 to 2011 to compare the outcomes of HSCT in patients with different co-morbid IMIDs with patients without any co-morbid IMIDs. In both our multivariate and stringent matched-pair analysis, ulcerative colitis (UC) was associated with increased mortality while rheumatoid arthritis and psoriasis were associated with lower mortality as compared to no IMID group. Furthermore, in allogeneic HSCT subgroup, UC was associated with higher mortality and psoriasis was associated with lower mortality. In conclusion, we found that depending on the type of HSCT, each IMID has a different impact on outcomes of HSCT. Furthermore, UC patients had increased mortality if they had primary sclerosing cholangitis and had a higher risk of opportunistic infections like tuberculosis and cytomegalovirus suggesting the need for increased vigilance in this cohort.

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