Outcomes of Lung Transplantation for Pulmonary Sarcoidosis Across Multiple Eras: A 25-Year Experience from a US Center
Keywords:
pulmonary sarcoidosis, lung transplantation, pulmonary fibrosis, pulmonary hypertensionAbstract
Background and aim: Sarcoidosis is a systemic condition with various clinical manifestations including end-stage lung disease. The aim of this study was to evaluate the characteristics and outcomes of patients with sarcoidosis undergoing lung transplantation.
Methods: A single center retrospective review was performed of 63 sarcoidosis patients who underwent lung transplantation between January 1, 2000 and April 30, 2025. Patients were divided into arbitrary equivalent tertiles (Era 1 2000-2007; Era 2 2007-2013; Era 3 2013-2025).
Results: The median age of the cohort was 53 years, 51% were female, 79% were black, 33% had blood type A, and the median body mass index was 24.4 kg/m2 (21.3-28.2). The majority (93%) of patients had pulmonary sarcoidosis stage IV by Scadding staging, and 89% had pulmonary hypertension. Baseline median six-minute walk test distance (6MWD) was 235 m (133-306). The median FVC% was 45%, median FEV1 was 37%, median FEV1/FVC was 73% (62-83) and median DLCO% was 26% (18-32). The median mean pulmonary artery pressure (mPAP) was 35 (26-44) mmHg, and the median pulmonary vascular resistance (PVR) was 4 (3-6) Wood Units (WU). Chronic lung allograft dysfunction (CLAD) occurred in 41% of patients at any point in time. Overall survival was 87.6%, 66% and 50.6% at 1, 3, and 5 years, respectively. The hazard ratio for mortality for era 1 vs era 3 was 0.888 (95% CI 0.407-1.94, p=0.766).
Conclusions: Outcomes of sarcoidosis patients who undergo lung transplantation are similar to patients with other underlying diagnoses. Timely referral should be made to specialized centers.
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