Little is known about outcomes following lung transplantation (LT) in patients with sarcoidosis. Additionally, results from LT for other interstitial lung diseases may not be generalizable to patients with sarcoidosis. One focus of efforts to improve the results of LT is to decrease early post-LT mortality. In order to facilitate this, we investigated causes of death following LT for sarcoidosis.
We reviewed the records of all patients with sarcoidosis who underwent LT in the US between Jan. 1995 and Dec. 2000. The primary study endpoint was cause of death at 30 days post-LT. We compared causes of death among those with sarcoidosis to those who underwent LT for other diseases. Cause of death was grouped into one of six categories: graft failure, infection (e.g., pneumonia, bacteremia, sepsis, etc), cardiovascular, pulmonary, cerebrovascular, or other. Reports as to cause of death were based on information provided by each LT center. One investigator evaluated each death that was initially classified as “other.” If appropriate, it was reclassified into an alternative category.
During the study period, 4721 LTs were performed of which 133 (2.8%) were for sarcoidosis. Unadjusted 30-day mortality rates were higher among those with sarcoidosis (17% vs 9%, p<0.0002). The most common cause of death among sarcoidosis patients was graft failure 39.1% (vs. 28.5%, p <0.001). Of patients who died, persons with sarcoidosis were 2.70 (95% CI: 1.34–5.45) times more likely to succumb from graft failure. Infections were responsible for few deaths in those with sarcoidosis (8.7% vs 22.1% of other LT recipients, p<0.001).CONCLUSIONS: Patients with sarcoidosis face significant short-term mortality after LT. Graft failure is a major barrier to improving survival. Reasons for the differential impact of graft failure in sarcoidosis are unclear.
Efforts to improve survival after LT for sarcoidosis should focus on prevention and early identification of graft failure.
A.F. Shorr, None.