Abstract Background Sarcoidosis is a granulomatous disease with systemic manifestations that affects the lungs in most patients. Advanced pulmonary sarcoidosis (pulmonary fibrosis, bronchiectasis, sarcoidosis associated pulmonary hypertension) carries a significant risk of mortality and is an indication for lung transplantation. Current literature suggests higher mortality on the lung transplant waitlist in patients with sarcoidosis compared to those with other forms of interstitial lung disease (ILD). However, post-transplant survival has been reported as similar in sarcoidosis when compared to other ILD. This study aims to evaluate long-term post-transplant outcomes, with a focus on the risk of chronic lung allograft dysfunction (CLAD) in sarcoidosis versus ILD recipients. Methods We conducted a retrospective cohort study using the TriNetX Research Network database, encompassing data from 2015 to 2024. Adult patients who underwent lung transplantation for sarcoidosis or ILD were identified. Propensity score matching (1:1) was applied based on demographics, comorbidities, and concurrent medications to balance groups. The primary outcome was the incidence of CLAD. Secondary outcomes included 5-year mortality and major adverse cardiac events (MACE). Results After matching, 500 patients were included in each group. The cohort had a mean age of 55.5 ± 9.5 years, with 59% male, 87% non-Hispanic, 52% White, and 41% Black or African American. The incidence of CLAD was significantly lower in the sarcoidosis group (2.6% vs. 5.2%; p = 0.0337; risk ratio RR 0.50, 95% CI 0.26-0.96). There was a trend towards lower 5-year mortality which was not statistically significant in the sarcoidosis group (21.0% vs. 23.8%; p = 0.2883; RR 0.882, 95% CI 0.7-1.112). MACE occurred more frequently in the sarcoidosis group compared to the other ILD group (69.8% vs. 62.4%; p = 0.0134; RR 1.119, 95% CI 1.023-1.223). Discussion In this matched cohort, lung transplant recipients with sarcoidosis had a significantly lower risk of CLAD compared to those with ILD but were at higher risk of MACE in the post-transplant period. There was no significant difference in 5-year mortality for individuals with sarcoidosis who underwent transplantation. This reduced risk of CLAD may be related to immunological differences sarcoidosis and other fibrotic ILDs. Sarcoidosis is characterized by granulomatous inflammation driven by dysregulated T-cell and macrophage responses, which may be more effectively suppressed by standard post-transplant immunosuppressive regimens compared to the progressive fibrotic processes in ILD where epithelial injury and dysregulated wound healing play larger roles. This abstract is funded by: None
Timilsina et al. (Fri,) studied this question.