Recurrence of Sarcoidosis Following Bilateral Allogeneic Lung Transplantation

Martínez, Fernando J.; Orens, Jonathan B.; Deeb, Michael; Brunsting, Louis A.; Flint, Andrew; Lynch, Joseph P.

doi:10.1378/chest.106.5.1597

Cited by 72 publications

(26 citation statements)

References 7 publications

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“…With regards to these patients' immunologic profiles, several studies have examined the incidence of acute and chronic rejection in this population and found no difference [97,98]. There have, however, been many reports of sarcoidosis recurrence in the allograft, with an estimated incidence as high as 66% [99][100][101]. The non-caseating granulomas evident on transbronchial lung biopsy specimens usually represent a histopathological curiosity, occasionally accompanied by radiographic abnormalities, but rarely resulting in physiological impairment or symptoms ( fig.…”

Section: Post-transplant Outcomesmentioning

confidence: 99%

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Management of end-stage sarcoidosis: pulmonary hypertension and lung transplantation

Shlobin¹,

Nathan²

2012

Eur Respir J

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Sarcoidosis is not only a multisystem, but also a multinational disease that is prevalent throughout the world, including Europe, the USA and Japan. Lung involvement in sarcoidosis is seemingly invariable, with up to 95% of patients manifesting some form of pulmonary disease during the course of their lifetime. The natural history of sarcoidosis in the lung is quite variable and spans the spectrum from spontaneous resolution to advanced fibrocystic disease in ,5% of cases. Advanced sarcoidosis will be the subject of this review with a special focus on pulmonary hypertension and lung transplantation as a last-resort treatment option for some patients with end-stage disease.

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Section: Post-transplant Outcomesmentioning

confidence: 99%

“…9). Nonetheless, there have been isolated case reports of clinically significant recurrence post-transplantation, that usually respond favourably to increased steroid therapy [99][100][101].…”

Section: Post-transplant Outcomesmentioning

confidence: 99%

Management of end-stage sarcoidosis: pulmonary hypertension and lung transplantation

Shlobin¹,

Nathan²

2012

Eur Respir J

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“…Even large transplant centers have collected only five cases [7,19]. However, recurrent sarcoidosis appears to be common after lung transplantation [7,11]. Diagnoses in these reported cases were substantiated by clinical and radiological methods.…”

Section: Introductionmentioning

confidence: 99%

Mycobacterial DNA in recurrent sarcoidosis in the transplanted lung - a PCR-based study on four cases

et al. 2000

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Sarcoidosis is a systemic granulomatous inflammation, which may be caused by mycobacteria other than M. tuberculosis complex (MOTT) in one-third of cases. A few cases of recurrent sarcoidosis in the transplanted lung have been reported. However, mycobacteria have been excluded by acid-fast stains only. We investigated four cases of recurrent sarcoidosis in lung transplant patients. Using PCR for the insertion sequence 6110 of Mycobacterium tuberculosis complex and a second PCR for the mycobacterial chaperonin (65-kDa antigen coding sequence), we looked for mycobacterial DNA. In three cases sequence analysis was also performed. One patient was negative for mycobacterial DNA in explanted, but positive for M. tuberculosis DNA in transplanted lung, qualifying this case as M. tuberculosis infection in the transplant. Three patients were negative for M. tuberculosis DNA, but were positive for MOTT-DNA in both explanted and transplanted lungs. In these three patients sequence identity of the amplified sequences before and after transplantation was proven, which rules out mycobacteriosis. Recurrent sarcoidosis does occur, but can only be proven by the exclusion of mycobacterial DNA. In cases of recurrent MOTT-DNA-positive sarcoidosis the diagnosis cannot be confirmed except by proof of sequence identity. Probably MOTT-DNA-positive sarcoidosis is more likely to recur in a transplanted lung.

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“…It has been suggested that the evolution of allograft rejection and sarcoid granulomas may share a common pathogenesis via activated T-lymphocytes [10,17]. However, it is conceivable that the formation of sarcoid granulomas and the mechanism of allograft rejection are governed by different immunological pathways [18].…”

Section: Discussionmentioning

confidence: 99%

Recurrent sarcoid granulomas in a transplanted lung derive from recipient immune cells: Fig. 1—

Milman¹,

Andersen²,

Burton³

et al. 2005

Eur Respir J

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From 1992From -2004, single lung transplantation has been performed in seven patients with end-stage pulmonary sarcoidosis at the Danish National Centre for Lung Transplantation. The objective was to assess whether recurrent sarcoid granulomas in the lung graft are derived from recipient or donor immune cells.Three patients had sarcoid recurrence in the lung graft, but none had clinically overt extrathoracic sarcoidosis. Graft sex-mismatch was present in one patient, a 52-yr-old female having a lung graft from a male donor. In order to discriminate between recipient and donor cells fluorescence in situ hybridisation (FISH), using probes for both X-and Y-chromosomes, was applied on transbronchial lung biopsies (TBB) from the lung graft containing sarcoid granulomas.The recipient's explanted lung contained multiple active sarcoid granulomas. TBB from the implanted donor lung 5 months after transplantation showed sarcoid granulomas. FISH showed that the immune cells in the granulomas were X-chromosome positive and Y-chromosome negative and, therefore, were derived from the recipient.In conclusion, the results indicate that recurrent sarcoid granulomas in the transplanted lung are derived from recipient's immune cells, having colonised the lung allograft.

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Recurrence of Sarcoidosis Following Bilateral Allogeneic Lung Transplantation

Cited by 72 publications

References 7 publications

Management of end-stage sarcoidosis: pulmonary hypertension and lung transplantation

Management of end-stage sarcoidosis: pulmonary hypertension and lung transplantation

Mycobacterial DNA in recurrent sarcoidosis in the transplanted lung - a PCR-based study on four cases

Recurrent sarcoid granulomas in a transplanted lung derive from recipient immune cells: Fig. 1—

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