Elsevier

Transplantation Proceedings

Volume 45, Issue 6, July–August 2013, Pages 2384-2386
Transplantation Proceedings

Emerging trends in transplantation
Thoracic transplantation
Heart Transplantation for End-Stage Heart Failure Due to Cardiac Sarcoidosis

https://doi.org/10.1016/j.transproceed.2013.02.116Get rights and content

Abstract

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.

Section snippets

Methods

We reviewed 19 patients with cardiac sarcoidosis who had end-stage heart failure treated with orthotopic heart transplantation from January 1991 to July 2010. All patients had pathologically proven sarcoidosis after pathologic examination of the explanted heart. The control group consisted of 1,050 patients without cardiac sarcoidosis who received a heart transplant during this same time period. The surgical technique7, 8, 9, 10 and the endomyocardial biopsy protocol11, 12, 13, 14 were

Results

The 19 heart transplant recipients with cardiac sarcoidosis ranged in age from 29 to 68 years, and 10 (53%) were male. Seven patients (37%) had hypertension, 4 (21%) diabetes mellitus type II, and 2 (11%) hyperlipidemia. Eight patients (42%) had known preoperative extracardiac sarcoidosis. Four patients (21%) had biopsy-confirmed cardiac sarcoidosis before transplant, and these patients, as well as the other 15 patients (79%), had cardiac sarcoidosis confirmed with pathologic examination of the

Discussion

Heart transplantation is not universally considered in end-stage heart failure patients with cardiac sarcoidosis, owing to concerns for sarcoid recurrence in the cardiac allograft and possible progression of disease in other organs. We reviewed the outcomes of cardiac transplantation in patients with cardiac sarcoidosis and compared the outcomes in patients without cardiac sarcoidosis who received a heart transplant during a similar time period.

In our study, there was no difference seen in

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