Sarcoidosis, race, and short-term outcomes following lung transplantation.

Chest

Pulmonary & Critical Care Medicine Service, Department of Medicine, Walter Reed Army Medical Center, Washington, DC 20307, USA.

Published: March 2004

AI Article Synopsis

  • The study focuses on short-term survival rates following lung transplantation (LT) for patients with sarcoidosis, revealing that around 83% survive past 30 days compared to 91% for other conditions.
  • Factors like requiring mechanical ventilation, being treated in an ICU, and donor age were linked to higher mortality rates, while African American patients faced nearly a 50% increased risk of death post-transplant.
  • Despite these differences, once controlling for various factors, survival rates for sarcoidosis patients were similar to those undergoing LT for other diseases, with graft failure being the leading cause of death for them.

Article Abstract

Background: Patients with sarcoidosis, many of whom are African American, may require lung transplantation (LT). Little is known about survival following LT for sarcoidosis.

Objective: To determine short-term mortality following LT for sarcoidosis, to evaluate if survival after LT for sarcoidosis is similar to outcomes after LT for other diseases, and to investigate the impact of race on the results of LT.

Design: Retrospective review.

Patients: All patients who underwent LT, irrespective of diagnosis, in the United States between January 1995 and December 2000.

Measurements: Vital status at 30 days after LT and cause of death.

Results: During the study period, 4,721 LTs were performed; of these 133 LTs (2.8%) were for sarcoidosis. Approximately 83% of patients with sarcoidosis survived following LT compared to 91% of persons undergoing transplantation for other reasons (p = 0.002). In multivariate analysis controlling both for health insurance status and other factors known to affect survival after LT, patients with sarcoidosis were no more likely to die than persons undergoing transplantation for other conditions (adjusted odds ratio for death, 1.45; 95% confidence interval [CI], 0.84 to 2.48). Significant predictors of mortality included the following: undergoing combined heart-lung transplant, need for mechanical ventilation, treatment in an ICU at time of LT, pre-LT FEV(1), need for supplemental oxygen, and donor age. Both recipient race and donor race significantly affected short-term survival. African-American patients were nearly 50% more likely to die (adjusted odds ratio, 1.49; 95% CI, 1.01 to 2.20). This difference based on race persisted after excluding heart-lung recipients and after controlling for recipient-donor racial mismatch. The most frequent cause of death for patients with sarcoidosis was graft failure, while infection was the primary cause of death among other LT patients.

Conclusions: Patients with sarcoidosis do as well as patients undergoing LT for other diseases. Race is an important factor affecting survival after LT.

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Source
http://dx.doi.org/10.1378/chest.125.3.990DOI Listing

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