LETTER
Sarcoidosis, Liver Transplantation, and Cyclosporine
Thomas Papo;
Jean-Charles Piette; and
Dominique Valla
1 December 1993 | Volume 119 Issue 11 | Pages 1148-1149
TO THE EDITOR:
Casavilla and colleagues [1] describe nine patients with sarcoidosis that was improved by immunosuppressive treatment given for prevention of liver allograft rejection. When compared with patients who had had transplants and did not have sarcoidosis, survival of these patients and their grafts was good. They concluded that cyclosporine may be beneficial in treating sarcoidosis, but several questions are unanswered. First, the favorable course may have been related to a benign form of sarcoidosis. What was the status of such prognostic variables as age, race, duration of disease, and type of visceral involvement? Comparison with control patients who had sarcoidosis and were matched for age, sex, extrahepatic sarcoidosis involvement, and corticosteroid treatment would have been more appropriate to assess the utility of therapy. Second, the patients may have been highly selected, representing those with visceral involvement limited to the native (and removed) liver. Third, a similar beneficial effect might have been achieved with corticosteroids and azathioprine; were these drugs used? Fourth, what were the end points used to assess treatment efficacy in sarcoidosis?
Spontaneous remission of sarcoidosis is known to occur in more than one half of all cases. Cyclosporine has been reported to be potentially deleterious in sarcoidosis [2, 3].
1. Casavilla FA, Gordon R, Wright HI, Galaver JS, Starzl TE, Van Thiel DH. Clinical course after liver transplantation in patients with sarcoidosis. Ann Intern Med. 1993; 118:865-6.
2. Cunnah D, Chew S, Wass J. Cyclosporin for central nervous system sarcoidosis. Am J Med. 1988; 85:580-1.
3. York FL, Kovithavongs T, Man P, Rebuck AS, Sproule BJ. Cyclosporine and chronic sarcoidosis. Chest. 1990; 98:1026-7.
About Letters
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
Top
References
Article
