Section of Pulmonary, Miami VA Healthcare System, Miami, FL, USA.
Division of Pulmonary and Critical Care, University of Miami, Miami, FL, USA.
Sci Rep. 2018 May 3;8(1):6968. doi: 10.1038/s41598-018-25144-x.
Sarcoidosis commonly affects the lung. Lung transplantation (LT) is required when there is a severe and refractory involvement. We compared post-transplant survival rates of sarcoidosis patients with chronic obstructive pulmonary disease (COPD) and idiopathic pulmonary fibrosis (IPF). We also explored whether the race and age of the donor, and double lung transplant have any effect on the survival in the post transplant setting. We analyzed 9,727 adult patients with sarcoidosis, COPD, and IPF who underwent LT worldwide between 2005-2015 based on United Network for Organ Sharing (UNOS) database. Survival rates were compared with Kaplan-Meier, and risk factors were investigated by Cox-regression analysis. 469 (5%) were transplanted because of sarcoidosis, 3,688 (38%) for COPD and 5,570 (57%) for IPF. Unadjusted survival analysis showed a better post-transplant survival rate for patients with sarcoidosis (p < 0.001, Log-rank test). In Cox-regression analysis, double lung transplant and white race of the lung donor showed to have a significant survival advantage. Since double lung transplant, those who are younger and have lower Lung Allocation Score (LAS) at the time of transplant have a survival advantage, we suggest double lung transplant as the procedure of choice, especially in younger sarcoidosis subjects and with lower LAS scores.
结节病通常影响肺部。当出现严重且难治性疾病时，需要进行肺移植（LT）。我们比较了结节病患者与慢性阻塞性肺疾病（COPD）和特发性肺纤维化（IPF）患者的移植后生存率。我们还探讨了供体的种族和年龄以及双肺移植是否会影响移植后的生存。我们根据美国器官共享网络（UNOS）数据库分析了 2005 年至 2015 年间全球因结节病、COPD 和 IPF 而接受 LT 的 9727 例成年患者。通过 Kaplan-Meier 比较生存率，并通过 Cox 回归分析探讨危险因素。469 例（5%）因结节病接受移植，3688 例（38%）因 COPD 接受移植，5570 例（57%）因 IPF 接受移植。未调整的生存分析显示，结节病患者移植后的生存率更高（p<0.001，对数秩检验）。在 Cox 回归分析中，双肺移植和肺供体的白人种族显示出明显的生存优势。由于双肺移植，那些在移植时年龄较小且肺分配评分（LAS）较低的患者具有生存优势，因此我们建议双肺移植作为首选手术，尤其是在年轻的结节病患者和 LAS 评分较低的患者中。
