Abstract Patients with sarcoidosis on the lung transplant waitlist face high mortality rates up to 17.3% in those with mPAP 30 mmHg and 14.3% in those ≤30 mmHg; surpassing COPD (9.8%) with an adjusted hazard ratio of 1.94, and similar to IPF, per national registry analyses. Access to transplantation remains limited for sarcoidosis patients, including factors like African American race (adjusted OR 2.5 for waitlist death) and sarcoidosis-associated pulmonary hypertension. Notably, post-transplant long term survival is comparable to other indications (86% at 1 year, 76% at 3 years, and median 6.1 years overall), with key prognostic factors: older age and extensive pre-operative fibrosis. The perioperative period is an important short-term outcome for which the literature is scant. This study addresses this critical gap by examining perioperative outcomes in adults with sarcoidosis compared to other ILD using national cohort data, highlighting an underappreciated layer of risk in this vulnerable population. We analyzed the NIS from 2016-2022, identifying adults with sarcoidosis or other ILD who underwent lung transplantation using ICD-10 codes. Primary outcomes included all cause in-hospital mortality, length of stay, and total hospital charges. Secondary analyses stratified outcomes by ILD subtype (pneumoconiosis, hypersensitivity pneumonitis, and other ILD). Multivariable logistic regression was performed, adjusted for age, race, income quartile, insurance type, and Elixhauser comorbidity index calculated via Van Walraven weights. Among 3,440 lung transplanted patients, 104 had sarcoidosis and 2,102 had other ILDs. Results showed that although length of stay and hospitalization costs were similar between sarcoidosis and other-ILDs, patients with sarcoidosis undergoing lung transplantation had double the odds of in-hospital mortality compared to those with other ILD (OR 2.03, 95% CI 1.43-2.90, p-value 0.0001). Secondary analysis also showed lower in-hospital mortality in pneumoconiosis (OR 0.26, 95% CI 0.10-0.71, p 0.01), hypersensitivity pneumonitis (OR 0.50, 95% CI 0.30-0.83, p 0.01), and other ILD types (OR 0.50, 95% CI 0.35-0.71, p 0.01) compared to sarcoid patients. This study reveals sarcoidosis patients undergoing lung transplantation experience higher in-hospital mortality compared to other ILD subtypes, offering novel insights into short-term risks extending known waitlist challenges. These findings suggest that disease specific pathophysiology such as extensive fibrosis, pulmonary hypertension, or multi-organ involvement may drive this elevated perioperative risk, in addition to health system or socioeconomic factors. To improve outcomes, strategies could include earlier referral for transplant evaluation, enhanced pre-operative optimization targeting sarcoidosis associated complications, and refined risk stratification models to prioritize high-risk candidates. This abstract is funded by: N/A
Timilsina et al. (Fri,) studied this question.