*Purpose: Cardiac sarcoidosis (CS) is a known etiology of end-stage dilated, hypertrophic, or arrhythmogenic cardiomyopathies requiring heart transplantation (HT). We sought to evaluate the long-term post-HT outcomes of patients with CS compared to patients without CS.

*Methods: A retrospective analysis of 63,142 HT patients from the United Network Organ Sharing (UNOS) registry from 1987 to 2019 was undertaken. Comparisons between patient characteristics of HT recipients with CS (N=288) and those without a diagnosis of CS (N=62,854) were made using standard statistical methods using Cox proportional hazards regression for survival analysis.

*Results: HT recipients with CS were more likely to be older (52.4 ± 9.0 vs 46.6 ± 19.2, p<0.001) and female (35.8% vs 26.2%, p<0.001). They were less likely to be smokers (24.7% vs 33.1%, p=0.002), to have diabetes (15.4% vs 20.6%, p=0.03), and to have undergone prior non-transplant cardiac surgery (12.2% vs 18.3%, p=0.01). In terms of transplant-related factors, sarcoid HT recipients more often received an older donor (32.1 ± 11.8 vs 28.2 ± 14.0, p<0.001) but had similar ischemic times and life support requirements at time of transplant. Prior to HT, the CS patients were less likely to require mechanical ventilation (0.3% vs 4.3%, p = 0.001) but had similar rate of ventricular assist device and extracorporeal membrane oxygenation requirements. Median time on the wait list was similar between CS and non-CS groups. There was significantly lower overall post-transplant mortality in the sarcoid HT recipients in the 150 months follow-up period (p<0.001).

*Conclusions: Cardiac sarcoidosis HT recipients are more likely to be older but have less underlying co-morbidities such as diabetes, smoking, and prior cardiac surgery. CS patients’ peri-operative acuity is similar to the non-CS end stage heart failure patients. However, they have improved long-term survival post-HT compared to the non-CS post-HT population. These findings suggest that clinicians should have a low threshold for diagnostic testing and work-up if cardiac sarcoidosis is suspected.

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