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Heart transplantation for end-stage heart failure due to cardiac sarcoidosis

D Perkel1, L S C Czer, R P Morrissey

  • 1Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California, USA.

Transplantation Proceedings
|August 20, 2013
PubMed

Insights

Heart transplantation offers favorable outcomes for cardiac sarcoidosis patients, with low rates of allograft recurrence. Long-term survival and freedom from major adverse events are comparable to controls, supporting transplantation as a viable option.

Area of Science:

  • Cardiology
  • Transplantation Immunology
  • Immunosuppression

Background:

  • Cardiac sarcoidosis leading to end-stage heart failure has a poor prognosis without heart transplantation.
  • Established data on sarcoid recurrence and rejection rates post-transplant are limited.

Purpose of the Study:

  • To evaluate the outcomes of heart transplantation in patients with cardiac sarcoidosis.
  • To assess the rates of sarcoid recurrence and rejection in heart transplant recipients with cardiac sarcoidosis.

Main Methods:

  • A retrospective comparison of 19 heart transplant recipients with cardiac sarcoidosis against 1,050 controls without the condition.
  • Outcomes assessed included 1-year freedom from treated rejection, 5-year survival, freedom from cardiac allograft vasculopathy (CAV), freedom from nonfatal major adverse cardiac events (NF-MACE), and sarcoid recurrence.
  • Patients with sarcoidosis received low-dose corticosteroids post-transplantation.

Main Results:

  • No significant differences were observed in 1-year rejection rates, 5-year survival, 5-year freedom from CAV, or 5-year freedom from NF-MACE between groups.
  • No instances of cardiac allograft sarcoidosis recurrence were reported.
  • Sixteen percent of patients experienced extracardiac sarcoid recurrence, with no associated mortality.

Conclusions:

  • Heart transplantation provides acceptable long-term outcomes for patients with cardiac sarcoidosis.
  • Low-dose corticosteroid immunosuppression appears to prevent allograft sarcoid recurrence and limit extracardiac progression.
  • Heart transplantation is a viable treatment for cardiac sarcoidosis patients with end-stage heart failure.
Abstract

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