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Lung transplantation for sarcoidosis: outcome and prognostic factors

Jérôme Le Pavec, Dominique Valeyre, Pierre Gazengel, Are M. Holm, Hans Henrik Schultz, Michael Perch, Aurélie Le Borgne, Martine Reynaud-Gaubert, Christiane Knoop, Laurent Godinas, Sandrine Hirschi, Vincent Bunel, Rosalia Laporta, Sergio Harari, Elodie Blanchard, Jesper M. Magnusson, Adrien Tissot, Jean-François Mornex, Clément Picard, Laurent Savale, Jean-François Bernaudin, Pierre-Yves Brillet, Hilario Nunes, Marc Humbert, Elie Fadel, Jens Gottlieb
European Respiratory Journal 2021 58: 2003358; DOI: 10.1183/13993003.03358-2020
Jérôme Le Pavec
1Service de Chirurgie Thoracique, Vasculaire et Transplantation Cardio-pulmonaire, Hôpital Marie-Lannelongue, Le Plessis-Robinson, France
2Université Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin Bicêtre, France
3UMR_S 999, Université Paris-Sud, INSERM, Hôpital Marie Lannelongue, Le Plessis Robinson, France
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Dominique Valeyre
4INSERM UMR 1272, Université Sorbonne Paris Nord, AP-HP, Hôpital Avicenne Service de Pneumologie, Bobigny, France
5Groupe Hospitalier Paris Saint Joseph, Paris, France
26These authors contributed equally to this work
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Pierre Gazengel
1Service de Chirurgie Thoracique, Vasculaire et Transplantation Cardio-pulmonaire, Hôpital Marie-Lannelongue, Le Plessis-Robinson, France
2Université Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin Bicêtre, France
3UMR_S 999, Université Paris-Sud, INSERM, Hôpital Marie Lannelongue, Le Plessis Robinson, France
26These authors contributed equally to this work
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Are M. Holm
6Dept of Respiratory Medicine, Oslo University Hospital and Institute for Clinical Medicine University of Oslo, Oslo, Norway
27These authors contributed equally to this work
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Hans Henrik Schultz
7Dept of Cardiology, Section for Lung Transplantation, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
27These authors contributed equally to this work
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Michael Perch
7Dept of Cardiology, Section for Lung Transplantation, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Aurélie Le Borgne
8Pôle des voies respiratoires-Hôpital Larrey, Centre Hopitalo-Universitaire, Toulouse, France
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Martine Reynaud-Gaubert
9Service de Pneumologie et Equipe de Transplantation Pulmonaire, Centre Hospitalo-Universitaire Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Marseille, France
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Christiane Knoop
10Brussels Lung Transplant Program, Dept of Chest Medicine, Erasme University, Brussels, Belgium
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Laurent Godinas
11Dept of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
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Sandrine Hirschi
12Service de Pneumologie, Groupe de Transplantation Pulmonaire, Hopitaux Universitaires de Strasbourg, Strasbourg, France
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Vincent Bunel
13AP-HP, Service de Pneumologie, Hôpital Bichat, Paris, France
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Rosalia Laporta
14Pneumology Dept, Hospital Universitario Puerta de Hierro, Madrid, Spain
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Sergio Harari
15Dept of Medical Sciences San Giuseppe Hospital MultiMedica IRCCS and Dept of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
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Elodie Blanchard
16Dept of Respiratory Medicine, Haut-Lévèque Hospital, Bordeaux University, Pessac, France
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Jesper M. Magnusson
17Dept of Internal Medicine/Respiratory Medicine and Allergology, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
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Adrien Tissot
18Service de Pneumologie, L'institut du thorax, Centre hospitalo-universitaire de Nantes, Nantes, France
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Jean-François Mornex
19Université de Lyon, INRA, IVPC, Lyon, France
20Hospices Civils de Lyon, Lyon, France
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Clément Picard
21Service de Pneumologie, Hôpital Foch, Suresnes, France
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Laurent Savale
2Université Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin Bicêtre, France
3UMR_S 999, Université Paris-Sud, INSERM, Hôpital Marie Lannelongue, Le Plessis Robinson, France
22AP-HP, Service de Pneumologie, Hôpital Kremlin Bicêtre, Kremlin Bicêtre, France
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Jean-François Bernaudin
23INSERM UMR 1272, Université Sorbonne Paris Nord, Bobigny and Sorbonne Université Paris, Paris, France
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Pierre-Yves Brillet
24INSERM U1272, Université Paris Sorbonne Nord, AP-HP, Service de Radiologie, Hôpital Avicenne, Bobigny, France
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Hilario Nunes
4INSERM UMR 1272, Université Sorbonne Paris Nord, AP-HP, Hôpital Avicenne Service de Pneumologie, Bobigny, France
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Marc Humbert
2Université Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin Bicêtre, France
3UMR_S 999, Université Paris-Sud, INSERM, Hôpital Marie Lannelongue, Le Plessis Robinson, France
22AP-HP, Service de Pneumologie, Hôpital Kremlin Bicêtre, Kremlin Bicêtre, France
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Elie Fadel
1Service de Chirurgie Thoracique, Vasculaire et Transplantation Cardio-pulmonaire, Hôpital Marie-Lannelongue, Le Plessis-Robinson, France
2Université Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin Bicêtre, France
3UMR_S 999, Université Paris-Sud, INSERM, Hôpital Marie Lannelongue, Le Plessis Robinson, France
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Jens Gottlieb
25Dept of Respiratory Medicine, Hannover Medical School, Hanover, Germany
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Abstract

Study question In patients with sarcoidosis, past and ongoing immunosuppressive regimens, recurrent disease in the transplant and extrapulmonary involvement may affect outcomes of lung transplantation. We asked whether sarcoidosis lung phenotypes can be differentiated and, if so, how they relate to outcomes in patients with pulmonary sarcoidosis treated by lung transplantation.

Patients and methods We retrospectively reviewed data from 112 patients who met international diagnostic criteria for sarcoidosis and underwent lung or heart–lung transplantation between 2006 and 2019 at 16 European centres.

Results Patient survival was the main outcome measure. At transplantation, median (interaquartile range (IQR)) age was 52 (46–59) years; 71 (64%) were male. Lung phenotypes were individualised as follows: 1) extended fibrosis only; 2) airflow obstruction; 3) severe pulmonary hypertension (sPH) and airflow obstruction; 4) sPH, airflow obstruction and fibrosis; 5) sPH and fibrosis; 6) airflow obstruction and fibrosis; 7) sPH; and 8) none of these criteria, in 17%, 16%, 17%, 14%, 11%, 9%, 5% and 11% of patients, respectively. Post-transplant survival rates after 1, 3, and 5 years were 86%, 76% and 69%, respectively. During follow-up (median (IQR) 46 (16–89) months), 31% of patients developed chronic lung allograft dysfunction. Age and extended lung fibrosis were associated with increased mortality. Pulmonary fibrosis predominating peripherally was associated with short-term complications.

Answer to the study question Post-transplant survival in patients with pulmonary sarcoidosis was similar to that in patients with other indications for lung transplantation. The main factors associated with worse survival were older age and extensive pre-operative lung fibrosis.

Abstract

Post-transplant survival in patients with pulmonary sarcoidosis was similar to that in patients with other indications for lung transplantation. The main factors associated with worse survival were older age and extensive pre-operative lung fibrosis. https://bit.ly/2XBfJd6

Footnotes

  • This article has supplementary material available from erj.ersjournals.com

  • Conflict of interest: J. Le Pavec has nothing to disclose.

  • Conflict of interest: D. Valeyre has nothing to disclose.

  • Conflict of interest: P. Gazengel has nothing to disclose.

  • Conflict of interest: A.M. Holm has nothing to disclose.

  • Conflict of interest: H.H. Schultz has nothing to disclose.

  • Conflict of interest: M. Perch has nothing to disclose.

  • Conflict of interest: A. Le Borgne has nothing to disclose.

  • Conflict of interest: M. Reynaud-Gaubert has nothing to disclose.

  • Conflict of interest: C. Knoop has nothing to disclose.

  • Conflict of interest: L. Godinas has nothing to disclose.

  • Conflict of interest: S. Hirschi has nothing to disclose.

  • Conflict of interest: V. Bunel has nothing to disclose.

  • Conflict of interest: R. Laporta has nothing to disclose.

  • Conflict of interest: S. Harari has nothing to disclose.

  • Conflict of interest: E. Blanchard has nothing to disclose.

  • Conflict of interest: J.M. Magnusson has nothing to disclose.

  • Conflict of interest: A. Tissot has nothing to disclose.

  • Conflict of interest: J-F. Mornex has nothing to disclose.

  • Conflict of interest: C. Picard has nothing to disclose.

  • Conflict of interest: L. Savale has nothing to disclose.

  • Conflict of interest: J-F. Bernaudin has nothing to disclose.

  • Conflict of interest: P-Y. Brillet has nothing to disclose.

  • Conflict of interest: H. Nunes has nothing to disclose.

  • Conflict of interest: M. Humbert has nothing to disclose.

  • Conflict of interest: E. Fadel has nothing to disclose.

  • Conflict of interest: J. Gottlieb has nothing to disclose.

  • Received September 2, 2020.
  • Accepted December 25, 2020.
  • Copyright ©The authors 2021. For reproduction rights and permissions contact permissions{at}ersnet.org
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Lung transplantation for sarcoidosis: outcome and prognostic factors
Jérôme Le Pavec, Dominique Valeyre, Pierre Gazengel, Are M. Holm, Hans Henrik Schultz, Michael Perch, Aurélie Le Borgne, Martine Reynaud-Gaubert, Christiane Knoop, Laurent Godinas, Sandrine Hirschi, Vincent Bunel, Rosalia Laporta, Sergio Harari, Elodie Blanchard, Jesper M. Magnusson, Adrien Tissot, Jean-François Mornex, Clément Picard, Laurent Savale, Jean-François Bernaudin, Pierre-Yves Brillet, Hilario Nunes, Marc Humbert, Elie Fadel, Jens Gottlieb
European Respiratory Journal Aug 2021, 58 (2) 2003358; DOI: 10.1183/13993003.03358-2020

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Lung transplantation for sarcoidosis: outcome and prognostic factors
Jérôme Le Pavec, Dominique Valeyre, Pierre Gazengel, Are M. Holm, Hans Henrik Schultz, Michael Perch, Aurélie Le Borgne, Martine Reynaud-Gaubert, Christiane Knoop, Laurent Godinas, Sandrine Hirschi, Vincent Bunel, Rosalia Laporta, Sergio Harari, Elodie Blanchard, Jesper M. Magnusson, Adrien Tissot, Jean-François Mornex, Clément Picard, Laurent Savale, Jean-François Bernaudin, Pierre-Yves Brillet, Hilario Nunes, Marc Humbert, Elie Fadel, Jens Gottlieb
European Respiratory Journal Aug 2021, 58 (2) 2003358; DOI: 10.1183/13993003.03358-2020
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