BACKGROUND: Cardiac sarcoidosis with end-stage heart failure has a poor prognosis without transplantation. The rates of sarcoid recurrence and rejection are not well established after heart transplantation. METHODS: A total of 19 heart transplant recipients with sarcoid of the explanted heart were compared with a contemporaneous control group of 1,050 heart transplant recipients without cardiac sarcoidosis. Assessed outcomes included 1st-year freedom from any treated rejection, 5-year actuarial survival, 5-year freedom from cardiac allograft vasculopathy (CAV), 5-year freedom from nonfatal major adverse cardiac events (NF-MACE), and recurrence of sarcoid in the allograft or other organs. Patients with sarcoidosis were maintained on low-dose corticosteroids after transplantation. RESULTS: There were no significant differences between the sarcoid and control groups in 1st-year freedom from any treated rejection (79% and 90%), 5-year posttransplantation survival (79% and 83%), 5-year freedom from CAV (68% and 78%), and 5-year freedom from NF-MACE (90% and 88%). Causes of death (n = 5) in the sarcoid group were coccidioidomycosis, pneumonia, rejection, hemorrhage, and CAV. No patient had recurrence of sarcoidosis in the cardiac allograft. Three of 19 patients (16%) experienced recurrence of extracardiac sarcoid, with no mortality. CONCLUSIONS: Patients with cardiac sarcoidosis undergoing heart transplantation have acceptable long-term outcomes without evidence of recurrence of sarcoidosis in the allograft when maintained on low-dose corticosteroids. Progression of extracardiac sarcoid was uncommon, possibly related to immunosuppression. In patients with cardiac sarcoidosis, heart transplantation is a viable treatment modality.
BACKGROUND:Cardiac sarcoidosis with end-stage heart failure has a poor prognosis without transplantation. The rates of sarcoid recurrence and rejection are not well established after heart transplantation. METHODS: A total of 19 heart transplant recipients with sarcoid of the explanted heart were compared with a contemporaneous control group of 1,050 heart transplant recipients without cardiac sarcoidosis. Assessed outcomes included 1st-year freedom from any treated rejection, 5-year actuarial survival, 5-year freedom from cardiac allograft vasculopathy (CAV), 5-year freedom from nonfatal major adverse cardiac events (NF-MACE), and recurrence of sarcoid in the allograft or other organs. Patients with sarcoidosis were maintained on low-dose corticosteroids after transplantation. RESULTS: There were no significant differences between the sarcoid and control groups in 1st-year freedom from any treated rejection (79% and 90%), 5-year posttransplantation survival (79% and 83%), 5-year freedom from CAV (68% and 78%), and 5-year freedom from NF-MACE (90% and 88%). Causes of death (n = 5) in the sarcoid group were coccidioidomycosis, pneumonia, rejection, hemorrhage, and CAV. No patient had recurrence of sarcoidosis in the cardiac allograft. Three of 19 patients (16%) experienced recurrence of extracardiac sarcoid, with no mortality. CONCLUSIONS:Patients with cardiac sarcoidosis undergoing heart transplantation have acceptable long-term outcomes without evidence of recurrence of sarcoidosis in the allograft when maintained on low-dose corticosteroids. Progression of extracardiac sarcoid was uncommon, possibly related to immunosuppression. In patients with cardiac sarcoidosis, heart transplantation is a viable treatment modality.
Authors: Eileen M Hsich; Joseph G Rogers; Dennis M McNamara; David O Taylor; Randall C Starling; Eugene H Blackstone; Jesse D Schold Journal: JACC Heart Fail Date: 2016-05-11 Impact factor: 12.035
Authors: Jan M Griffin; Ersilia M DeFilippis; Hannah Rosenblum; Veli K Topkara; Justin A Fried; Nir Uriel; Koji Takeda; Maryjane A Farr; Mathew S Maurer; Kevin J Clerkin Journal: Clin Transplant Date: 2020-10-28 Impact factor: 2.863
Authors: Z H Ahmadi; Sh Shafaghi; M H Mandegar; M Salehi; B Sharif Kashani; F Naghashzadeh; A Jahangirifard; A Bakhshandeh; A Afshar; M Kazempour; F Sheikhan Journal: Int J Organ Transplant Med Date: 2021
Authors: Joseph P Lynch; Jennifer Hwang; Jason Bradfield; Michael Fishbein; Kalyanam Shivkumar; Roderick Tung Journal: Semin Respir Crit Care Med Date: 2014-07-09 Impact factor: 3.119
Authors: Nisha A Gilotra; Jan M Griffin; Noelle Pavlovic; Brian A Houston; Jessica Chasler; Colleen Goetz; Jonathan Chrispin; Michelle Sharp; Edward K Kasper; Edward S Chen; Ron Blankstein; Leslie T Cooper; Emer Joyce; Farooq H Sheikh Journal: J Card Fail Date: 2021-07-11 Impact factor: 5.712