Thirty-Year Experience of Lung Transplantation for Pulmonary Sarcoidosis

Lung transplantation is a curative treatment for end-stage pulmonary sarcoidosis. Outcomes and prevalence of sarcoidosis recurrence are not well established despite sarcoidosis being the most common disease to recur following lung transplantation. We sought to evaluate our institution's experience of lung transplantation for pulmonary sarcoidosis.

This was a retrospective, single-centre study on consecutive lung transplant recipients for pulmonary sarcoidosis from December 1994 to March 2024. Medical records were reviewed for trans-bronchial biopsies (TBBxs), thoracic computed tomography (CT), positron emission tomography (PET), and spirometry. Post-transplant clinical outcomes and survival were explored.

We reviewed 40 patients who underwent lung transplantation for pulmonary sarcoidosis out of 1,789 total lung transplantations between January 1994 and March 2024. Fourteen (35%) had pulmonary sarcoidosis recurrence. The average age at transplant was 51 years and time from transplant to recurrence was 15 months. The predominant CT finding in sarcoidosis recurrence was right upper lobe nodules (42%). More than half (60%) of non-necrotising granulomas on TBBx were detected outside the surveillance protocol, at a median 9-month post-transplant. Two of 3 patients treated with infliximab for recurrence had complete metabolic response on PET. Patients with sarcoidosis recurrence were younger at time of transplant than those without recurrence (44 vs. 54.6 years, p < 0.001) and trended toward improved overall survival (15.1 vs. 8.2 years, p = 0.23).

Sarcoidosis recurrence was common and did not have a significant impact on survival after lung transplantation. Right upper lobe nodules on CT and inclusion of a 9-month surveillance TBBx may be useful in identifying sarcoidosis recurrence.