Lung transplantation is increasingly common among patients with coal workers' pneumoconiosis

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• Personal Author:
  Blackley DJ ; Cummings, Kristin J. ; Halldin, Cara N. ; Laney AS
• Description:
  Rationale: The prevalence of coal workers' pneumoconiosis (CWP) in U.S. coal miners has increased since the late 1990s, and severe presentations are becoming more common. Studies during the last decade have described rapid progression of CWP, increases in the prevalence of progressive massive fibrosis and CWP resembling silicosis, changes in radiographic and histopathologic disease patterns, severe disease in surface miners, increases in years of potential life lost attributable to CWP, and rising numbers of black lung disability claims. There is no cure for CWP, which can continue to progress after cessation of coal mine dust exposure. Supportive therapies don't slow progression, and some patient have undergone lung transplantation. Methods: Using data from the United Network for Organ Sharing, we identified U.S. patients with a primary diagnosis of CWP or pneumoconiosis unspecified, receiving lung transplants during December 31, 1995 - December 31, 2014. We describe trends in lung transplantation, summarize recipient characteristics, and estimate median survival using the Kaplan-Meier method. Results: Twenty-three patients with a diagnosis of CWP and 23 with pneumoconiosis unspecified received lung transplants during the study period (Figure); 34 (74%) occurred during 2008-2014. Nineteen of 23 patients with pneumoconiosis unspecified were residents of West Virginia, Virginia, Kentucky, or Pennsylvania - major coal producing states. All 46 patients were male, 44 were white, and the mean age was 56 years. Mean FEV1% predicted was 36%, and mean FVC% predicted was 53%. Patients were waitlisted for a mean of 157 days, and 28 (61%) received a bilateral transplant. Medicare paid for 18 (39%) of the transplants, followed by private insurance (n = 16, 35%), unspecified government insurance (n = 11, 24%), and Medicaid (n = 1, 2%). Twenty-one recipients were deceased as of December 31, 2014, and median survival was 3.7 years. Conclusions: CWP remains a serious occupational health concern. The pattern of lung transplants performed for CWP and pneumoconiosis unspecified, which likely represents CWP, is consistent with the resurgence of progressive massive fibrosis observed in coal miners. These data suggest survival in patients undergoing lung transplantation for CWP may be lower than for patients with other indications, and further characterization is warranted. These transplants reflect the use of a scarce resource for an entirely preventable disease, and highlight the need for enhanced efforts to reduce coal mine dust exposures. In the meantime, given the absence of a curative treatment, miners should continue to be considered as lung transplant candidates. [Description provided by NIOSH]
• Subjects:
  Coal Coal Mining Environmental Exposure Fibrosis Lung Lung Diseases Mining Morbidity Mortality Occupational Health Radiation Respiratory System Respiratory Tract Diseases Risk Assessment Risk Factors Safety

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• Keywords:
  Black Lung Disease Coal Miners Coal Mining Coal Workers Pneumoconiosis Diseases Exposure Levels Histopathology Miners Morbidity Rates Mortality Rates Pneumoconiosis Radiography Respiratory Function Respiratory Health Risk Factors Silicosis Surface Mining Surveillance Underground Mines Underground Mining

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• ISSN:
  1073-449X
• Document Type:
  Text
• Genre:
  Abstract or Summary
• Place as Subject:
  California ; OSHA Region 3 ; OSHA Region 9 ; West Virginia
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  RHD - Respiratory Health Division
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  193
• NIOSHTIC Number:
  nn:20048473
• Citation:
  Am J Respir Crit Care Med 2016 May; 193(Abstract Issue):A3000
• Email:
  xdc2@cdc.gov
• Federal Fiscal Year:
  2016
• Peer Reviewed:
  False
• Source Full Name:
  American Journal of Respiratory and Critical Care Medicine
• Supplement:
  Abstract Issue
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:9db9885573d67e875f6b71a6e963a6d053366b05549d161ee93c029e02fc1ca579856c39bfc0c65240e78da94c335f49d804deac0942fa89485fb9d31c0013ee
• Download URL:
  https://stacks.cdc.gov/view/cdc/203222/cdc_203222_DS1.pdf
• File Type:
  [PDF - 147.45 KB ]