Outcomes of lung transplantation for pulmonary sarcoidosis across multiple eras: A 25-Year experience from a US center

Background and aim: Sarcoidosis is a systemic condition with various clinical manifestations including end-stage lung disease. The aim of this study was to evaluate the characteristics and outcomes of patients with sarcoidosis undergoing lung transplantation. Methods: A single center retrospective review was performed of 63 sarcoidosis patients who underwent lung transplantation between January 1, 2000 and April 30, 2025. Patients were divided into arbitrary eras by year (Era 1 2000-2007; Era 2 2007-2013; Era 3 2013-2025). Results: The median age of the cohort was 53 years, 51% were female, 79% were black, 33% had blood type A, and the median body mass index was 24.4 kg/m² (21.3-28.2). The majority (93%) of patients had pulmonary sarcoidosis stage IV by Scadding staging, and 89% had pulmonary hypertension. Baseline median six-minute walk test distance (6MWD) was 235 m (133-306). The median FVC% was 45% (34-50), median FEV₁ was 37% (26-45), median FEV₁/FVC was 73% (62-83) and median DLCO% was 26% (18-32). The median mean pulmonary artery pressure (mPAP) was 35 (26-44) mmHg, and the median pulmonary vascular resistance (PVR) was 4 (3-6) Wood Units (WU). Chronic lung allograft dysfunction (CLAD) occurred in 38% of patients at a median 85 months post-transplant. Overall survival was 87.6%, 66% and 50.6% at 1, 3, and 5 years, respectively. There was no statistically significant difference in mortality across eras: era 1 vs era 3 (HR 0.888, 95% CI 0.407-1.94, p=0.766). Conclusions: Outcomes of sarcoidosis patients who undergo lung transplantation are similar to patients with other underlying diagnoses. Timely referral should be made to specialized centers.