title: Disease Recurrence and Acute Cellular Rejection Episodes During the First Year After Lung Transplantation Among Patients With Sarcoidosis.
abstract: BACKGROUND
  Sarcoidosis is reported to recur after lung transplantation (LT). We sought to determine the frequency of recurrent disease after LT and predictors of recurrence. We also evaluated the incidence and severity of acute cellular rejection (ACR) episodes among these patients.
  
  
  METHODS
  The database of LT patients at Cleveland Clinic was interrogated for sarcoidosis patients who underwent LT between May 1993 and 2011. Charts were reviewed for demographics, type of transplant, posttransplant biopsy findings, and outcomes.
  
  
  RESULTS
  Data were available for 30 patients (mean age, 50 ± 9.3 years; range, 30-65 years; M-to-F ratio, 17:13; single-to-double-to-heart lung ratio, 5:24:1). Recurrence of sarcoidosis was noted among 7 patients (pathological recurrence in all and radiological findings suggesting recurrence in 1 patient) with no impact on overall outcomes. Presence of granulomas on explanted lungs was the only predictor of recurrence (85.7% vs 30.4%, odds ratio, 13.7; 1.4-136.2; P = 0.02).Overall burden of ACR episodes on all bronchoscopies was significantly lower in patients with disease recurrence (7.6 % vs 21.3% of biopsies, P = 0.038). Among patients with recurrent disease, ACR did not develop once disease recurrence had been seen on transbronchial biopsy.
  
  
  CONCLUSIONS
  A significant proportion of sarcoidosis patients have disease recurrence after LT and presence of active granulomas on explant is associated with subsequent recurrence. There may be an association of recurrence with lower frequency of ACR episodes. There does not appear to be any impact of sarcoidosis recurrence on 1-, 3-, or 5-year survivals.
authors.affiliation: 1 Lung Transplant Program, Division of Pulmonary and Critical Care Medicine, UT Southwestern Medical Center, Dallas, TX. 2 Division of Pulmonary and Critical Care Medicine, Respiratory Institute, Cleveland Clinic Foundation, Cleveland OH. 3 Department of Anatomic Pathology, Cleveland Clinic Foundation, Cleveland OH.
authors.forename: Amit
authors.initials: A
authors.lastname: Banga
authors.forename: Debasis
authors.initials: D
authors.lastname: Sahoo
authors.forename: Charles R
authors.initials: CR
authors.lastname: Lane
authors.forename: Carol F
authors.initials: CF
authors.lastname: Farver
authors.forename: Marie M
authors.initials: MM
authors.lastname: Budev
mesh_terms: D000208:Acute Disease; D000328:Adult; D001706:Biopsy; D001999:Bronchoscopy; D016208:Databases, Factual; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis / Q000276:immunology* / Q000401:mortality; D015769:Granuloma, Respiratory Tract / Q000453:epidemiology; D006801:Humans; D007111:Immunity, Cellular; D015994:Incidence; D053208:Kaplan-Meier Estimate; D016040:Lung Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009820:Ohio / Q000453:epidemiology; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D017565:Sarcoidosis, Pulmonary / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D012720:Severity of Illness Index; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome