Recurrence of sarcoidosis after heart and lung transplantation: a retrospective single-centre cohort study

To determine the incidence of sarcoidosis recurrence following heart or lung transplantation and to characterize recurrence patterns and clinical features in a single-centre cohort.

We conducted a retrospective cohort study using the Stanford Medicine Research Data Repository from 2008 to 2022. Adult patients with pulmonary or cardiac sarcoidosis who underwent lung or heart transplantation were identified using International Classification of Diseases codes and confirmed by manual chart review. Clinical characteristics, treatment history and outcomes were extracted. The primary outcome was recurrence of sarcoidosis in the transplanted organ. Secondary outcomes included recurrence in non-transplanted organs, graft loss, rejection and mortality. Time to recurrence was evaluated using Kaplan-Meier analysis.

Fifty-eight sarcoidosis patients met inclusion criteria (22 pulmonary, 36 cardiac). Recurrence in the transplanted organ occurred in seven of 58 patients (12.1%): one of 22 lung transplant recipients (4.5%) and six of 36 heart transplant recipients (16.7%). Recurrence in non-transplanted organs occurred in one pulmonary recipient (4.5%) and five cardiac recipients (13.9%). One cardiac recipient experienced recurrence in both transplanted and extra-transplant sites. Among heart transplant recipients, patients with recurrence were older (mean 60.8 vs 55.2 years), whereas comorbidities, pre-transplant therapies and post-transplant immunosuppressive regimens were similar. Mean follow-up was 5.7 vs 6.2 years for pulmonary and cardiac recipients, respectively.

Sarcoidosis recurrence occurred after both lung and heart transplantation and was more common after heart transplantation in this cohort. Recurrence despite standard immunosuppression supports ongoing surveillance and further study of recurrence mechanisms and prevention strategies.