Management of Cardiac Sarcoidosis Post Heart Transplantation: Survey of Transplant Centers

Abstract

Background: Cardiac sarcoidosis (CS) can result in end stage infiltrative cardiomyopathy. Heart transplantation (HT) is an effective therapy for advanced CS, with outcomes similar to non-CS patients. Rarely, recurrence of sarcoidosis in the allograft can occur. Ideal immunosuppression and surveillance strategies in patients with CS are unknown. The aim of our study is to look at practice patterns regarding treatment of CS patients post HT. Methods: A survey concerning HT attitudes and outcomes in CS patients was distributed to 98 HT centers in the United States via email. Results: Twenty-six centers responded to the survey (28%). In year 2018 alone, these centers did 964 transplants. All centers reported having performed HT in CS patients, reported approximately 194 HT in CS patients. Most centers reported similar outcomes for patients with CS compared to other etiologies (96.4%). 17(72%)centers report using mechanical circulatory support as bridge to transplant. Regarding post-HT management of these patients, 62.5% of participants reported a dedicated immunosuppression strategy for CS patients with most respondents reporting long-term steroid use in patients with CS and 37.5 % of participants using induction therapy for CS patients (with either thymoglobulin or basiliximab). Approximately 37.5% of participants have seen recurrence of sarcoidosis post HT in the allograft ranging from 0 to 50% recurrence either in allograft or other site. 28% of respondents reported performing prolonged surveillance for sarcoid recurrence with 34.8% using either PET scan or Cardiac MR for evaluation. This survey sheds light into post-transplant management of patients with CS with most centers reporting recurrence of sarcoidosis in the allograft and using long term steroids to prevent recurrence.