Sarcoidosis Lung Transplantation Waitlist Mortality, a National Registry Database Study

Abstract

The Lung Allocation Score prioritizes lung transplantation candidates balancing waitlist-mortality and post-transplant survival. The score groups sarcoidosis candidates based on mean pulmonary artery pressure: ≤30 mmHg (Sarcoidosis A) are grouped with COPD and >30 mmHg (Sarcoidosis D) with idiopathic pulmonary fibrosis. We hypothesize that sarcoidosis candidates have a higher waitlist-mortality than other candidates within their LAS grouping. This is a retrospective cohort study of consecutive lung transplantation candidates from the Scientific Registry of Transplant Recipients database from May 2005 to May 2019. We included candidates ≥18 y/o diagnosed with sarcoidosis, COPD or IPF. Univariate, multivariate and survival estimate analysis were performed. We identified 385 sarcoidosis A, 642 sarcoidosis D, 7081 COPD, 10 639 IPF lung transplantation candidates. 17.3% of sarcoidosis D, 14.8% of IPF, 14.3% of sarcoidosis A, and 9.8% of COPD candidates died awaiting transplant. Sarcoidosis A was an independent risk factor for waitlist-mortality. Sarcoidosis A had a lower waitlist survival probability compared to COPD. Sarcoidosis D had the highest waitlist-mortality. IPF candidates had lower waitlist survival probability than sarcoidosis D in the first 60 days after listing. Based on our results the grouping of candidates with sarcoidosis in the allocation systems should be revised to mitigate the waitlist-mortality disparity.