Outcomes of Lung Transplantation for Sarcoidosis in the Lung Allocation Score Era

Sarcoidosis is an uncommon indication for lung transplantation, and survival for these recipients has not been fully characterized. We investigated outcomes after lung transplantation for sarcoidosis in comparison to more common indications.

United Network for Organ Sharing data were retrospectively reviewed for lung transplant candidates and recipients listed for sarcoidosis, chronic obstructive pulmonary disease (COPD), or idiopathic pulmonary fibrosis (IPF) between 2005 and 2023. Survival and perioperative outcomes were compared among groups.

Of the 20,411 lung transplant recipients, 918 (4.5%) had sarcoidosis, 7,421 (36.4%) had COPD, and 12,072 (59.1%) had IPF. Sarcoidosis recipients were younger, more frequently Black, and had higher mean pulmonary artery pressures at listing (all p < 0.001). Waitlist mortality for sarcoidosis patients was higher than that of COPD patients but lower than that of IPF patients (p < 0.001). Posttransplant, sarcoidosis recipients experienced higher early morbidity and worse unadjusted short-term survival; however, long-term survival exceeded that of COPD and IPF recipients. After adjusting for age, transplant type, and sub-era (early vs late LAS), sarcoidosis was associated with similar posttransplant mortality to that of IPF and COPD. Among patients with sarcoidosis, elevated serum creatinine and prior cardiac surgery were risk factors for both short- and long-term posttransplant mortality. Poor functional status and pretransplant diabetes were also associated with increased posttransplant mortality in this population.

Despite increased perioperative morbidity, lung transplant recipients with sarcoidosis had long-term survival comparable to that of COPD and IPF recipients. Lung transplantation is an efficacious treatment for end-stage pulmonary sarcoidosis.