Abstract 4368030: Impact of Timing and Pattern of Diagnosis on Outcomes in Cardiac Sarcoidosis Patients Undergoing Heart Transplantation: A Meta-Analytic Perspective

Background: Cardiac sarcoidosis (CS) is a rare but increasingly recognized indication for heart transplantation (HTx). While current guidelines include CS in transplant considerations, clinical uncertainty remains as to whether the timing and pattern of diagnosis—early clinical recognition vs. incidental histological diagnosis at explantation—affect post-transplant outcomes. Research Question: We hypothesized that timing and pattern of CS diagnosis influence post-HTx outcomes. Specifically, patients diagnosed before listing (early-recognized) may have worse outcomes due to systemic inflammation, whereas those diagnosed incidentally at explant (incidental CS) may represent cardiac-limited disease with more favorable prognosis. Methods: We conducted a meta-analytic review of published studies reporting post-HTx outcomes in CS patients. Cases were grouped as: (1) Early-recognized CS: diagnosed pre-listing, often with clinical or historical suspicion of systemic or extracardiac involvement. (2) Incidental CS: diagnosed solely via histological exam of explanted hearts, typically without prior systemic involvement. Outcomes were compared between these groups and with non-CS recipients within the same datasets. Results: Across six studies including >18,500 HTx recipients, 182 CS patients were identified (88 early-recognized, 94 incidental). Early-recognized CS showed 1- and 5-year survival of 78.5–79%, recurrence in up to 14%, and a trend toward increased acute rejection. These patients often required stronger immunosuppression, yet systemic inflammation may have persisted. In contrast, incidental CS showed similar or better survival (5-year up to 83%), minimal recurrence, and lower rejection rates, suggesting milder or cardiac-limited disease. UNOS-based analyses revealed lower acute rejection risk in CS vs. non-CS (OR 0.56) with similar survival. Conclusions: The timing and pattern of CS diagnosis appear to impact post-transplant outcomes. Patients with incidental, cardiac-limited CS identified at explantation may experience favorable outcomes, whereas those with early-recognized CS and possible prior systemic involvement may face higher recurrence risk. These findings support individualized approaches to immunosuppression and transplant candidacy evaluation in CS.