Cardiac Transplantation as Surgical Treatment for Cardiac
Sarcoidosis
Ali Ghodsizad MD, PhD, FACC, FETCS, FACS
Sarcoidosis is a complex disease with different clinical presentations
that can involve multiple organs (1). The lung is typically the most
common organ involved, multiple organ involvements with pulmonary and
cardiac sarcoidosis account for most of the morbidity and mortality
observed with this disease (1). Cardiac sarcoidosis presents as a
progressive infiltrative cardiomyopathy that can lead to heart failure,
arrhythmia and death (1).
Here McGoldrick and colleagues report on their database study with data
from Organ Procurement and
Transplantation Network (OPTN) involving 289 cardiac sarcoidosis
patients with end stage restrictive cardiomyopathy, who needed cardiac
transplantation and compared them with all non-sarcoid patients
undergoing cardiac transplantation for restrictive cardiomyopathy and
end stage heart failure of other causes between Jan 1999 to March 2020
(n=41447).
Patients with cardiac sarcoidosis had a comparable survival to
non-sarcoid patients at 1 and 5 years and a significantly longer
survival at up to 10 years.
Patients with cardiac sarcoidosis had an increased chance to die from
aspergillus infections at 1 year. Jackson et al showed in their
multicenter trial comparable survival, rate of graft failure, and
incidence of treated rejection at 1 year when compared to matched
non-sarcoid patients. Sarcoid patients after heart transplantation were
less likely to be hospitalized for infection in their study at 1 year
(2). Liu et al performed a similar UNOS data base study showing that
cardiac sarcoidosis heart transplant recipients were an older population
with less underlying co-morbidities with a lower overall mortality (3).
The diagnosis of cardiac sarcoidosis in patients who undergo left
ventricular assist device implantation can be confirmed by histological
examination of myocardium at the time of ventricular assist device
insertion, but unclear is the predictive value (4,5).
McGoldrick and colleagues excluded patients who required multiorgan
transplantation in all 3 groups and we have to consider that multiorgan
recipients belong to the sickest subpopulation.
McGoldrick et al and other groups confirm the role of cardiac
transplantation as a viable option for patients with cardiac
sarcoidosis. Considering the increasing number of the cardiac
transplantation for sarcoidosis in recent years, the 10 years survival
data may have to be reevaluated with more follow up time in future.