Lung Transplantation in Advanced Pulmonary Sarcoidosis

Despite the advent of precision medicine in advanced pulmonary sarcoidosis, a subset of patients will experience ongoing disease progression, requiring lung transplantation as salvage therapy. Lung transplant survival outcomes in sarcoidosis patients are comparable to other interstitial lung disease patients receiving lung transplant. However, because sarcoidosis is a systemic inflammatory disease, there are specific features unique to sarcoidosis that must be accounted for throughout the transplant process. Herein, we comprehensively review lung transplantation for advanced pulmonary sarcoidosis, including indications, outcomes, evaluation, transplant laterality (single vs. bilateral lung), and post-transplant monitoring. Evaluation for sarcoidosis comorbidities, including bronchiectasis, pulmonary hypertension, non-pulmonary organ involvement, especially cardiac involvement, and ongoing anti-inflammatory therapy are essential when considering lung transplant candidacy. Hemothorax, primary graft dysfunction, and post-lung transplant disease recurrence are seen at increased rates in sarcoidosis lung transplant patients and must be thoroughly evaluated for pre- and post-transplant. Lung transplantation is the final option for advanced pulmonary sarcoidosis patients refractory to maximal medical management. Improved understanding of the unique challenges sarcoidosis patients face pre- and post-transplant is needed to maximize their survival and quality of life.