Sarcoidosis affects multiple systems, but lung involvement is the most common presentation, found in over 70% of sarcoid patients. In the lungs, the disease causes inflammation related to granulomas, which can lead to scarring. If a patient’s lung capacity deteriorates despite treatment and falls below 50% or they become dependent on supplemental oxygen, they may be a candidate for transplant, says H. Azfar Ali, MD, transplant pulmonologist and director of the Duke Pulmonary Sarcoid Clinic.
Early referral is vital to transplant
At Duke, patients receive a multidisciplinary evaluation for solid-organ transplants, including assessing other organs’ function, supporting any necessary lifestyle changes, and providing support from psychologists, social workers, and insurance specialists. “Early referral gives our multidisciplinary team time to make sure a patient is prepared and optimized mentally and physically so they’re ready when they need transplant,” says Ali.
“As soon as a patient needs supplemental oxygen or pulmonary function regresses despite first- or second-line sarcoidosis treatments, consider referring,” Ali continues.
Research indicates patients with pulmonary sarcoidosis have a disproportionately higher risk of death on the transplant waiting list. Duke’s median wait time for lung transplant is 15 days, the best in the U.S. Additionally, if other organs are affected by sarcoidosis or other conditions, Duke ranked among the top 10 programs nationally for multi-organ transplants for 2023.
Transplant for sarcoidosis
When patients with end-stage sarcoidosis require a lung transplant, surgery can be challenging, Ali says. “These patients have significant scarring in the chest. This requires longer surgical time and may cause more bleeding, but our surgeons have experience handling that.”
Sarcoidosis patients are also at increased risk of fungal infections related to mycetomas. “At Duke, we have protocolized treatments for these complications,” says Ali. “After surgery, sarcoidosis patients face slightly higher complication risk. Large volume centers have the advantage of experience in dealing with peri- and post-operative complications.”
Long term, patients’ prognosis is similar to lung transplant recipients with other conditions such as idiopathic pulmonary fibrosis or chronic obstructive pulmonary disease.
Although granulomas are likely to recur in implanted lungs, Ali says recurrence does not affect lung function. “Transplant patients’ anti-rejection drugs can also treat sarcoidosis, so recurrence of clinically significant disease is quite low.”
As the patient returns to community care post-transplant, Duke physicians communicate with referring physicians about the patient’s ongoing needs. “We want to partner with physicians for the best outcomes for their patients,” says Ali.