Understanding outcomes from lung transplant (LT) is central to both more efficient organ allocation and to efforts targeted at improving recipient survival. Unlike idiopathic pulmonary fibrosis (IPF), sarcoidosis (SAR) generally affects younger patients who therefore have the potential to live for longer durations after LT. However, little is known about survival following LT for SAR.
We reviewed the records of all patients with either SAR or IPF who underwent LT in the US from Jan 1994 to Dec 2002. Mortality at 2 years following LT served as the primary endpoint. To examine potential confounders which might affect survival we also recorded patient demographics, lung function, pulmonary hemodynamics, functional status, and corticosteroid use.
The final study cohort included 197 patients with SAR and 1155 subjects with IPF. Those with SAR were younger than persons with IPF (mean age: 46.7 vs. 53.9 yrs, p <0.01). Nonetheless, individuals with SAR had worse lung function at time of LT (FVC 43.5 ± 15.6 vs. 48.2 ± 16.8 % predicted, p<0.01). Pulmonary hypertension was also more common in SAR (mean PA pressure 33.2 ± 12.3 vs. 25.3 ± 10.5 mm Hg, p<0.01). Prior to LT there was no difference in the proportion of patients with either disease hospitalized, requiring substantial assistance with their activities of daily living, or classified as corticosteroid dependent by the LT center. Two-year actuarial survival was similar between the two populations (61% for SAR vs. 62% for IPF, p=0.45). In each cohort, the greatest decline in survival occurred during the first year following LT.
Patients with SAR appear to be more severely ill when listed for LT compared to persons with IPF. However, intermediate-term outcomes for LT for SAR are similar to those seen in LT for IPF.
Those with SAR seem to do well with LT. Concern about the effect of LT on survival in SAR should not preclude physicians from referring patients with advanced SAR for LT evaluation.
Andrew Shorr, None.