Recurrence of sarcoidosis after heart and lung transplantation: a retrospective single-center cohort study

Abstract Objectives To determine the incidence of sarcoidosis recurrence following heart or lung transplantation and to characterize recurrence patterns and clinical features in a single-center cohort. Methods We conducted a retrospective cohort study using the Stanford Medicine Research Data Repository from 2008-2022. Adult patients with pulmonary or cardiac sarcoidosis who underwent lung or heart transplantation were identified using International Classification of Diseases codes and confirmed by manual chart review. Clinical characteristics, treatment history, and outcomes were extracted. The primary outcome was recurrence of sarcoidosis in the transplanted organ. Secondary outcomes included recurrence in non-transplanted organs, graft loss, rejection, and mortality. Time-to-recurrence was evaluated using Kaplan–Meier analysis. Results Fifty-eight sarcoidosis patients met inclusion criteria (22 pulmonary, 36 cardiac). Recurrence in the transplanted organ occurred in 7 of 58 patients (12.1%): 1 of 22 lung transplant recipients (4.5%) and 6 of 36 heart transplant recipients (16.7%). Recurrence in non-transplanted organs occurred in 1 pulmonary recipient (4.5%) and 5 cardiac recipients (13.9%). One cardiac recipient experienced recurrence in both transplanted and extra-transplant sites. Among heart transplant recipients, patients with recurrence were older (mean 60.8 vs. 55.2 years), whereas comorbidities, pre-transplant therapies, and post-transplant immunosuppressive regimens were similar. Mean follow-up was 5.7 vs 6.2 years for pulmonary and cardiac recipients respectively. Conclusion Sarcoidosis recurrence occurred after both lung and heart transplantation and was more common after heart transplantation in this cohort. Recurrence despite standard immunosuppression supports ongoing surveillance and further study of recurrence mechanisms and prevention strategies.