Researcher Identifies Increased Survival Factors for Sarcoidosis Patients with Lung Transplants
Sarcoidosis patients have better outcomes with lung transplants than patients with chronic obstructive pulmonary disease or idiopathic pulmonary fibrosis. Their survival outlook is also greater when the donor is young or white, or when receiving a double lung transplant, according to a University of Miami Miller School of Medicine researcher who is an expert on this rare inflammatory lung disease.
“We recommend that sarcoidosis patients with advanced lung disease be evaluated for lung transplant in an early stage, and double lung transplants should be the preferred procedure,” said Mehdi Mirsaeidi, M.D., M.P.H., assistant professor in the Department of Medicine’s Division of Pulmonary and Critical Care, and director of the University of Miami and U.S. Department of Veterans Affairs’ sarcoidosis programs.
Mirsaeidi was the senior author of a study, “White Donor, Younger Donor and Double Lung Transplant Are Associated with Better Survival in Sarcoidosis Patients,” published recently in Scientific Reports. Miller School co-authors were Shirin Shafazand, M.D., M.S., associate professor of medicine, and Michael A. Campos, M.D., associate professor of medicine.
In sarcoidosis, inflammatory blood cells typically collect and grow in the lung, lymph nodes, eyes, and skin. When there is a severe impact on the lungs, transplantation is required for survival. Women are twice as likely to have the disease as men, and the lifetime risk for African Americans is 2.5 percent, compared with 0.85 percent for Caucasians. Overall, there are fewer than 200,000 cases per year in the U.S.
“In the past decade, we have seen many advances in lung transplantation, resulting in an overall improvement in survival rates,” Mirsaeidi said. “However, there are still many questions that need to be answered regarding the selection of recipients, the timing of transplants and the donated organs.”
In the new large-scale study, Mirsaeidi’s collaborative research team compared post-transplant survival rates of patients with sarcoidosis, chronic obstructive pulmonary disease (COPD) and idiopathic pulmonary fibrosis (IPF) — the three most common reasons for transplants. They analyzed 9,727 adult patients with sarcoidosis, COPD, and IPF who underwent lung transplants worldwide between 2005 and 2015, based on the United Network for Organ Sharing database.
The comprehensive study showed a 53 percent 10-year survival rate for sarcoidosis patients, compared with a 45 percent five-year survival rate for patients with COPD and 44 percent for those with IPF. Cystic fibrosis lung transplant patients, while fewer in number, had a five-year survival rate of 67 percent in previous studies, he added.
“We also found that the race of the donor had an impact on post-transplant outcomes,” Mirsaeidi said. “We are planning further research on African-American donor organs to identify the reasons, which could be related to genetics or to differences in microbiomes [organisms] in the body.”
“Our research clearly provides a roadmap for better survival rates for clinicians treating patients with sarcoidosis of the lungs,” Mirsaeidi said. “We also believe a new disease-specific lung transplant scoring system should be designed to determine the best time to refer a sarcoidosis patient for lung transplantation.”