Sarcoidosis and transplantation

Abstract

Background and aim of work: Organ transplantation is an accepted treatment for patients with end-stage organ failure. There is limited information about transplantation in patients with sarcoidosis. While there has been no systematic study of transplantation in sarcoidosis, there have been several reports of patients with sarcoidosis undergoing organ transplantation. The purpose of this review is to analyze the available literature.

Methods: We reviewed the literature regarding transplantation of kidney, liver, heart, heart-lung and lung in patients with sarcoidosis with attention to survival, complications and the incidence of recurrence of sarcoidosis in the transplanted organ and at distant sites.

Results: Survival and complication rates are similar to those of patients undergoing transplantation for other indications. Recurrence of pulmonary sarcoidosis has been estimated to be 47% following lung transplantation. The published cases represent a fraction of the patients reported to the International Registry maintained by the United Network of Organ Sharing (UNOS).

Conclusions: Transplantation can be carried out safely in patients with sarcoidosis. Recurrence is frequent, often asymptomatic, and does not compromise graft function or patient survival. Radiographic abnormalities or symptoms associated with recurrence are responsive to increased adrenocorticosteroid therapy. Exacerbation of sarcoidosis in transplant recipients occurs in the setting of intense immunosuppression.