Lung transplantation in sarcoidosis

Area of Science:

• Pulmonology
• Transplant Surgery
• Immunology

Background:

• Pulmonary sarcoidosis is a severe fibrocystic lung disease often refractory to medical treatment.
• Lung transplantation (LT) is a therapeutic option for advanced cases, with survival rates comparable to other indications.
• High mortality rates (27-53%) among sarcoidosis patients awaiting LT highlight challenges in timely referral.

Purpose of the Study:

• To review indications and contraindications for LT in sarcoidosis patients.
• To examine risk factors influencing mortality in sarcoidosis patients undergoing or awaiting LT.
• To discuss optimal timing for LT referral in sarcoidosis, considering predictive model limitations.

Main Methods:

• Review of existing literature on lung transplantation for pulmonary sarcoidosis.
• Analysis of retrospective studies identifying mortality risk factors.
• Evaluation of predictive models for mortality in interstitial lung diseases and their applicability to sarcoidosis.

Main Results:

• Pulmonary function tests poorly correlate with mortality risk in sarcoidosis.
• Pulmonary arterial hypertension is a significant predictor of mortality and warrants LT referral.
• Recurrent sarcoidosis in lung allografts does not negatively impact survival or complication risk.

Conclusions:

• LT is a suitable treatment for severe, medically refractory pulmonary sarcoidosis.
• Early referral is essential for timely evaluation, despite challenges in predicting mortality.
• Careful consideration of sarcoidosis-specific risks allows for reasonable transplant outcomes.