Transplantation for sarcoidosis

The course and prognosis of sarcoidosis varies greatly. A characteristic feature is the high rate of spontaneous remission, however, chronic disease may occur in 10–30% of patients. Chronic sarcoidosis is defined as disease which persists for w2 yrs. Mortality from sarcoidosis is only 1–5%, but 75% of all deaths are due to advanced pulmonary sarcoidosis. To date, it remains difficult to predict which patients may develop chronic progressive severe disease. Regrettably, the treatment options for chronic stage IV sarcoidosis are limited. Generally, lung transplant is reserved for those who have failed to respond to maximal medical therapy. Due to the variability of the clinical course of sarcoidosis, timing of transplant can be difficult. Accurate, disease-specific predictors of mortality in sarcoidosis patients with chronic pulmonary disease have not been well defined. Furthermore, the relative rarity of end-stage sarcoidosis makes the creation of mortality prediction models difficult. This chapter will review both the current understanding of the optimal criteria applied for estimating the need for transplantation and the outcome of sarcoidosis patients who undergo transplantation.