End-stage sarcoidosis is characterized by severe pulmonary fibrosis and often poorly responsive to medical therapy. Lung transplantation, therefore, may be the only treatment option. Currently, there are few studies evaluating long-term outcomes following transplantation for these patients. The aim of this investigation is to evaluate the post-transplant morbidity and mortality of patients with sarcoid, compared to recipients transplanted for idiopathic pulmonary fibrosis (IPF).
This study is a retrospective review of all lung transplant recipients at a tertiary care center over a 10-year time period (1994-2004). Data collected include patient demographics, bronchoscopy results, spirometry, development of bronchiolitis obliterans syndrome (BOS), and median survival post-transplantation.
Over the study period, 300 patients underwent lung transplantation. Fourteen (4.7%) had sarcoidosis and 48 (16.0%) had IPF. Recipients in the sarcoid group were younger (mean age 41.3 versus 55.8 years*) and predominantly female (93% versus 38%*), compared to recipients in the IPF group at the time of transplant (* p < 0.01, Mann-Whitney). Five of 14 (36%) sarcoid patients developed BOS versus 15 of 48 (31%) IPF patients (p=ns). There was no significant difference in the time to BOS onset. Median survival was 1,365 days for the sarcoid group and 1,593 days for the IPF group (Hazard Ratio 1.28 by Kaplan-Meier analysis; [95% CI] 0.55-3.14; p = 0.54).
We observe similar long term outcomes for sarcoid and IPF recipients following lung transplantation.
Lung transplantation remains an option for the treatment of end-stage sarcoidosis, as BOS and mortality rates post-transplant are comparable to IPF.
Amit Gaggar, None.