Heart Transplant Outcomes for Patients with Cardiac Sarcoidosis

Abstract

Cardiac sarcoidosis (CS) is a known etiology of both end-stage dilated and restrictive cardiomyopathy requiring heart transplantation. We sought to evaluate the long-term post-transplant outcomes of patients with CS compared to patients without CS. We evaluated the United Network of Organ Sharing (UNOS) registry for all heart transplant (HT) recipients from 1987 to 2019. Comparisons between patient characteristics of HT recipients with CS (N=288) and HT recipients without a diagnosis of CS (N=62,854) were reported using standard statistical methods including Cox proportional hazards regression for survival analysis. Sarcoid HT recipients were significantly older (52.4 ± 9.0 vs. 46.6 ± 19.2, p<0.001) and were more likely to be female (35.8% vs. 26.2%, p<0.001). Sarcoid HT recipients were also less likely to have diabetes (15.4% vs. 20.6%, p=0.03) and to have undergone prior cardiac surgery (12.2% vs. 18.3%, p=0.01). In terms of transplant related factors, sarcoid HT recipients were more likely to receive an older donor (32.1 ± 11.8 vs. 28.2 ± 14.0, p<0.001), but had similar ischemic times. Prior to transplant, the CS patients were less likely to require mechanical ventilation (0.3% vs. 4.3%, p=0.001), but had similar rate of ventricular assist device (VAD) and extracorporeal membrane oxygenation (ECMO) requirements. Median time on the wait list was similar between both groups, however there was a lower overall post-transplant mortality in the sarcoid HT recipients (p<0.001). Cardiac sarcoidosis HT recipients tended to be an older population with less underlying co-morbidities such as diabetes and prior cardiac surgery. They were more likely to receive older donors. Although sarcoid HT recipients have similar organ wait times as non-CS recipients, they ultimately have a lower overall mortality.