The lungs are the organs most often affected by sarcoidosis, an inflammatory disease where the immune system mistakenly attacks the body’s own tissues and organs.

In sarcoidosis, small clusters of inflammatory cells called granulomas accumulate in the lungs and elsewhere. In 20-30 percent of all cases, these granulomas can cause permanent lung damage, which is a leading cause of sarcoidosis-related death.

If severe enough, the removal and replacement — a transplant — of the damaged lung may be advised.

About lung transplantation

A lung transplant involves replacing a damaged lung with one from a matched and healthy donor. In most cases, only the most damaged lung is replaced, but double lung transplants are sometimes undertaken.

Donor lungs typically come from a recently deceased person whose lungs were healthy. If only one lung is replaced, a living donor is possible, but typically requires two people donating a part of one lung, the lobe. In all cases, a very close tissue match between patient and donor is necessary to prevent organ rejection.

The damaged lung is removed and the donated lung installed through chest surgery while the patient is under general anesthesia. If two lungs are being transplanted, then an artificial breathing machine is used to allow the patient to breathe during the procedure.

The surgery typically takes four to eight hours for a single lung transplant, and six to 12 hours for a double lung transplant. Recovery time can be from a week to up to a month, or until monitoring and testing shows that the transplant was successful and the patient is healing well. During this time, patients are usually kept on a breathing machine until they can breathe comfortably on their own.

There are many risks involved with a lung transplant, including bleeding, infections, blocked blood vessels or airways, blood or fluid in the lungs, and rejection. Survival rates are fairly high and rising, however, with current estimates showing five in every 10 people living for at least five years after a lung transplant, and many living for at least 10 years.

Lung transplantation and sarcoidosis

Patients with late-stage sarcoidosis with significant lung damage may be eligible for a lung transplant, although a low risk of the donated organ to also being damaged by sarcoidosis is known.

If other organs are also severely damaged by the disease, a lung transplant may not be an option. However, for most late-stage sarcoidosis patients, lung transplantation is a viable treatment option that can improve disease symptoms and extend a quality life. A 2013 review article published in the Annals of the American Thoracic Society recommends a lung transplant be considered for patients with severe sarcoidosis-related lung damage.

This recommendation is supported by a 1998 study and a 2016 study, both published in the journal Thorax. These studies tracked lung transplant recipients over time, including people with sarcoidosis. Survival and quality of life in these patients  was found not to be similar to those with other conditions at three or five years post-transplant. Even in cases where sarcoidosis developed in the donated lung, resulting damage was usually not severe and the person’s overall health good.

Life after a lung transplant

A lung transplant requires lifelong care. Patients are usually followed by a multi-disciplinary team that can provide them with medical, social, and emotional support.

Keeping a healthy lifestyle, including getting regular check-ups, engaging in healthy levels of physical activity, getting plenty of sleep, and eating a balanced diet rich in fresh fruits and vegetables, is highly recommended. Patients should also avoid exposure to lung irritants, such as dust, chemical fumes, and cigarette smoke to maintain the health of their lungs.

People who have had a lung transplant, like other organ transplant recipients, are prescribed immunosuppressants. They will need to use these medications for the rest of their lives, to prevent their immune system from rejecting the transplanted organ. Immunosuppressants increase the risk of disease and infection, so patients should take measures to avoid becoming ill. But they also work to prevent sarcoidosis progression and ease symptoms, especially when coupled with a healthy lifestyle.

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