Recurrence of sarcoidosis among patient undergoing lung transplantation: Characteristic and outcomes

Lung transplantation is a last resort option available for end stage sarcoidosis; but the disease has a high tendency to recur in the transplanted lung despite immunosuppression and steroid therapy. This study was conducted to report our experience regarding the recurrence of pulmonary sarcoidosis after lung transplantation, to identify variables associated with recurrence and to study its impact on outcome. Methods: A retrospective chart review of all patients undergoing lung transplantation for sarcoidosis between Jan 1991 to August 2012 was conducted. We defined recurrence as presence of non-caseating granulomas on transbronchial lung biopsy (pathological recurrence) or typical radiological changes consisting of multiple peribronchovascular nodules (radiological recurrence). The explanted lungs were also reviewed for presence of granulomas. Results: Thirty eight patients were transplanted with listing diagnosis of sarcoidosis from 1993 till July 2012. Charts of 33 patients (mean age 50±9.3 years, range 30-65 years; M:F 19:15, C:AA 15:19, Single lung/Double lung /Double lung +Heart 5:27:1) charts were available for analysis (excluded patients: three - explant suggestive of alternate diagnosis namely IPF, GLILD, PCH; one had been recently transplanted and one chart not available for review). Recurrence occurred among 18% of the patients (n=6, M:F 4:2, C:AA 3:3). Recurrence was seen as early as 6 weeks and as late as 2.5 years. All disease recurrence was diagnosed on transbronchial biopsy showing non caseating granulomas. Radiologic recurrence occurred in one patient with peribronchovascular nodules. One year survival was 81%. Recurrence of sarcoidosis had no impact on survival. The only predictor of recurrence was presence of granulomas on explanted lungs (83.3% vs 31.25%, OR 8.33, P=0.04). Conclusion: Pulmonary Sarcoidosis tends to recur after lung transplantation in a significant proportion of patients. It is diagnosed incidentally on routine surveillance transbronchial biopsy. Patients with granulomas on explant have significantly higher chance of recurrence. Recurrence of pulmonary sarcoidosis does not impact survival.