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Lung transplantation for end-stage pulmonary sarcoidosis: outcome in a series of seven consecutive patients.

BACKGROUND
From 1992 through October 2004, in total 379 lung transplantations (LTx) have been performed at this center. The aim was to describe the course of LTx in 7 consecutive patients with end-stage pulmonary sarcoidosis.


METHODS
There were 5 men and 2 women. Figures are median (range). Pretransplantation data: Age at debut of sarcoidosis: 32 y (17-44). Duration of sarcoidosis until LTx: 13 y (10-30). None had significant extrapulmonary sarcoidosis. Chest X-ray showed stage III-IV sarcoidosis. All patients were NYHA class III-IV. Pulmonary function in per cent of predicted: FEV1 20% (15-75), FVC 43% (27-75), DLCO 26% (17-60).


RESULTS
All patients had single lung transplantation (SLTx) at a median age of 51 y (45-55). The perioperative course was uncomplicated. Follow-up was 30 months (11-135). A 47-year-old woman died 22 months post-LTx due to bronchiolitis obliterans syndrome (BOS) with graft failure. Maximum pulmonary function tests at 2-6 months post-LTx: FEV1 57% (52-91), FVC 69% (63-110). Acute rejection episodes (A2-A3) were median 3 (0-4). BOS at follow-up: 1 patient has BOS grade 0-p, 1 patient grade 1, 2 patients had grade 2, and 2 patients had grade 3. Recurrence of sarcoidosis in the transplanted lung occurred in 3 patients 1-6 months after SLTx, without deterioration in lung function.


CONCLUSIONS
Lung transplantation in patients with end-stage pulmonary sarcoidosis does not differ significantly with respect to morbidity or mortality compared with patients having other lung diseases. Recurrence of sarcoidosis in the transplanted lung occurs in approximately 50% of the patients, but apparently has no significant impact on lung function or on short-term outcome.