Lung transplantation for sarcoidosis: outcome and prognostic factors.

In patients with sarcoidosis, past and ongoing immunosuppressive regimens, recurrent disease in the transplant and extrapulmonary involvement may affect outcomes of lung transplantation. We asked whether sarcoidosis lung phenotypes can be differentiated and, if so, how they relate to outcomes in patients with pulmonary sarcoidosis treated by lung transplantation. We retrospectively reviewed data from 112 patients who met international diagnostic criteria for sarcoidosis and underwent lung or heart-lung transplantation between 2006 and 2019 at 16 European centres. Patient survival was the main outcome measure. At transplantation, median (interaquartile range (IQR)) age was 52 (46-59) years; 71 (64%) were male. Lung phenotypes were individualised as follows: 1) extended fibrosis only; 2) airflow obstruction; 3) severe pulmonary hypertension (sPH) and airflow obstruction; 4) sPH, airflow obstruction and fibrosis; 5) sPH and fibrosis; 6) airflow obstruction and fibrosis; 7) sPH; and 8) none of these criteria, in 17%, 16%, 17%, 14%, 11%, 9%, 5% and 11% of patients, respectively. Post-transplant survival rates after 1, 3, and 5 years were 86%, 76% and 69%, respectively. During follow-up (median (IQR) 46 (16-89) months), 31% of patients developed chronic lung allograft dysfunction. Age and extended lung fibrosis were associated with increased mortality. Pulmonary fibrosis predominating peripherally was associated with short-term complications. Post-transplant survival in patients with pulmonary sarcoidosis was similar to that in patients with other indications for lung transplantation. The main factors associated with worse survival were older age and extensive pre-operative lung fibrosis.

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Déclaration de conflit d'intérêts

Conflict of interest: J. Le Pavec has nothing to disclose. Conflict of interest: D. Valeyre has nothing to disclose. Conflict of interest: P. Gazengel has nothing to disclose. Conflict of interest: A.M. Holm has nothing to disclose. Conflict of interest: H.H. Schultz has nothing to disclose. Conflict of interest: M. Perch has nothing to disclose. Conflict of interest: A. Le Borgne has nothing to disclose. Conflict of interest: M. Reynaud-Gaubert has nothing to disclose. Conflict of interest: C. Knoop has nothing to disclose. Conflict of interest: L. Godinas has nothing to disclose. Conflict of interest: S. Hirschi has nothing to disclose. Conflict of interest: V. Bunel has nothing to disclose. Conflict of interest: R. Laporta has nothing to disclose. Conflict of interest: S. Harari has nothing to disclose. Conflict of interest: E. Blanchard has nothing to disclose. Conflict of interest: J.M. Magnusson has nothing to disclose. Conflict of interest: A. Tissot has nothing to disclose. Conflict of interest: J-F. Mornex has nothing to disclose. Conflict of interest: C. Picard has nothing to disclose. Conflict of interest: L. Savale has nothing to disclose. Conflict of interest: J-F. Bernaudin has nothing to disclose. Conflict of interest: P-Y. Brillet has nothing to disclose. Conflict of interest: H. Nunes has nothing to disclose. Conflict of interest: M. Humbert has nothing to disclose. Conflict of interest: E. Fadel has nothing to disclose. Conflict of interest: J. Gottlieb has nothing to disclose.