title: Heart transplantation for end-stage heart failure due to cardiac sarcoidosis.
abstract: BACKGROUND
  Cardiac sarcoidosis with end-stage heart failure has a poor prognosis without transplantation. The rates of sarcoid recurrence and rejection are not well established after heart transplantation.
  
  
  METHODS
  A total of 19 heart transplant recipients with sarcoid of the explanted heart were compared with a contemporaneous control group of 1,050 heart transplant recipients without cardiac sarcoidosis. Assessed outcomes included 1st-year freedom from any treated rejection, 5-year actuarial survival, 5-year freedom from cardiac allograft vasculopathy (CAV), 5-year freedom from nonfatal major adverse cardiac events (NF-MACE), and recurrence of sarcoid in the allograft or other organs. Patients with sarcoidosis were maintained on low-dose corticosteroids after transplantation.
  
  
  RESULTS
  There were no significant differences between the sarcoid and control groups in 1st-year freedom from any treated rejection (79% and 90%), 5-year posttransplantation survival (79% and 83%), 5-year freedom from CAV (68% and 78%), and 5-year freedom from NF-MACE (90% and 88%). Causes of death (n = 5) in the sarcoid group were coccidioidomycosis, pneumonia, rejection, hemorrhage, and CAV. No patient had recurrence of sarcoidosis in the cardiac allograft. Three of 19 patients (16%) experienced recurrence of extracardiac sarcoid, with no mortality.
  
  
  CONCLUSIONS
  Patients with cardiac sarcoidosis undergoing heart transplantation have acceptable long-term outcomes without evidence of recurrence of sarcoidosis in the allograft when maintained on low-dose corticosteroids. Progression of extracardiac sarcoid was uncommon, possibly related to immunosuppression. In patients with cardiac sarcoidosis, heart transplantation is a viable treatment modality.
authors: Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California, USA.
authors: D
authors: D
authors: Perkel
authors: L S C
authors: LS
authors: Czer
authors: R P
authors: RP
authors: Morrissey
authors: A
authors: A
authors: Ruzza
authors: M
authors: M
authors: Rafiei
authors: M
authors: M
authors: Awad
authors: J
authors: J
authors: Patel
authors: J A
authors: JA
authors: Kobashigawa
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000328:Adult; D000368:Aged; D009202:Cardiomyopathies / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D005260:Female; D006084:Graft Rejection / Q000209:etiology; D006085:Graft Survival; D006333:Heart Failure / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D016027:Heart Transplantation / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D012507:Sarcoidosis / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents