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Original research
Transplantation for work-related lung disease in the USA
  1. David J Blackley1,
  2. Cara N Halldin1,
  3. J W Awori Hayanga2,
  4. A Scott Laney1
  1. 1 Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
  2. 2 Cardiovascular and Thoracic Surgery, West Virginia University School of Medicine, Morgantown, West Virginia, USA
  1. Correspondence to Dr A Scott Laney, Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA; aol4{at}


Objectives Work-related lung diseases (WRLDs) are entirely preventable. To assess the impact of WRLDs on the US transplant system, we identified adult lung transplant recipients with a WRLD diagnosis specified at the time of transplant to describe demographic, payer and clinical characteristics of these patients and to assess post-transplant survival.

Methods Using US registry data from 1991 to 2018, we identified lung transplant recipients with WRLDs including coal workers’ pneumoconiosis, silicosis, asbestosis, metal pneumoconiosis and berylliosis.

Results The frequency of WRLD-associated transplants has increased over time. Among 230 lung transplants for WRLD, a majority were performed since 2009; 79 were for coal workers’ pneumoconiosis and 78 were for silicosis. Patients with coal workers’ pneumoconiosis were predominantly from West Virginia (n=31), Kentucky (n=23) or Virginia (n=10). States with the highest number of patients with silicosis transplant were Pennsylvania (n=12) and West Virginia (n=8). Patients with metal pneumoconiosis and asbestosis had the lowest and highest mean age at transplant (48.8 and 62.1 years). Median post-transplant survival was 8.2 years for patients with asbestosis, 6.6 years for coal workers’ pneumoconiosis and 7.8 years for silicosis. Risk of death among patients with silicosis, coal workers’ pneumoconiosis and asbestosis did not differ when compared with patients with idiopathic pulmonary fibrosis.

Conclusions Lung transplants for WRLDs are increasingly common, indicating a need for primary prevention and surveillance in high-risk occupations. Collection of patient occupational history by the registry could enhance case identification and inform prevention strategies.

  • pneumoconioses
  • transplantation
  • occupational health practice

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  • Contributors DJB analysed and interpreted the data, led writing of the article and takes responsibility for its content. ASL, JWAH and CNH assisted with interpreting data and writing the article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer The content of this manuscript is the responsibility of the authors and does not necessarily reflect

    the views of the Department of Health and Human Services, the Centers for Disease Control and

    Prevention, or the National Institute for Occupational Safety and Health.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The NIOSH Institutional Review Board (IRB) determined that this study did not require IRB review, and activities were covered by a signed data use agreement with the United Network for Organ Sharing.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request. The data reported here have been supplied by the United Network for Organ Sharing as the contractor for the OPTN. The interpretation and reporting of these data are the responsibility of the authors and should not be seen as an official policy of or interpretation by the OPTN or the US Government. These data are available on request with a signed data use agreement.

  • Author note This paper was prepared and written by National Institute for Occupational Safety and Health (NIOSH) employees as part of their employment.