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Published on: May 8, 2020
Isolated cardiac sarcoidosis in heart transplantation
1Department of Cardiovascular Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
Insights
Heart transplantation offers a viable treatment for end-stage heart failure caused by cardiac sarcoidosis. This study found no recurrence of sarcoidosis in transplanted hearts, suggesting a positive long-term prognosis.
Area of Science:
- Cardiology
- Transplantation Medicine
- Immunology
Background:
- Cardiac sarcoidosis is a rare cause of end-stage heart failure.
- Long-term outcomes of heart transplantation for cardiac sarcoidosis are not well-established.
- This study examines clinical and pathological findings in heart transplant recipients with isolated cardiac sarcoidosis.
Purpose of the Study:
- To evaluate the efficacy and long-term prognosis of heart transplantation in patients with isolated cardiac sarcoidosis.
- To assess the recurrence rate of sarcoidosis in allografted hearts.
- To present clinical and pathological observations in this patient cohort.
Main Methods:
- Retrospective review of five patients who underwent heart transplantation between 1987 and 2011.
- Analysis of clinical presentations, pathological findings, and post-transplant outcomes.
- Inclusion of endomyocardial biopsies for sarcoidosis assessment.
Main Results:
- Five patients (4 male, 1 female, ages 31-40) with isolated cardiac sarcoidosis underwent transplantation.
- Common presentations included atrioventricular block, ventricular arrhythmia, and poor left ventricular ejection fraction.
- All patients survived without allograft failure, with no observed recurrence of sarcoidosis up to 8 years post-transplant.
Conclusions:
- Heart transplantation is an effective treatment for end-stage heart failure due to isolated cardiac sarcoidosis.
- Diagnosis can be challenging pre-transplant, even with endomyocardial biopsy.
- No recurrence of cardiac sarcoidosis was noted in the transplanted allografts.
Background:
Heart transplantation is the ultimate treatment for end-stage heart failure. Cardiac sarcoidosis has rarely been reported in heart transplantation worldwide. Their long-term prognosis after heart transplantation is unknown. Herein we have presented clinical and pathological observations among heart transplantation patients with isolated cardiac sarcoidosis.
Methods:
From 1987 to 2011, we performed 411 heart transplantations including five patients retrospectively reviewed due to the presence of sarcoidosis and giant-cell cardiomyopathy in the recipient heart.
Results:
Among the heart transplantations from 2003 to 2011, the four male and one female patients were ages 31 to 40 years. None of them had extra-cardiac sarcoidosis. All five subjects presented with dilated cardiomyopathy with patent coronary arteries. The commonest clinical presentations were atrioventricular block, ventricular arrhythmia, electrocardiographic findings of ST elevations, and poor left ventricular ejection fractions (17%-23%). All patients survived without allograft heart failure to date with the longest survivor at 8 years postoperatively. No recurrence of sarcoidosis has been observed clinically or among the post-heart transplantation endomyocardial biopsies.
Conclusion:
Heart transplantation is a useful treatment for isolated cardiac sarcoidosis patients suffering end-stage heart failure. Often the diagnosis is difficult to establish before heart transplantation despite endomyocardial biopsy. No recurrence of sarcoidosis was observed among the allografted hearts.
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