Continued increase in lung transplantation for coal workers' pneumoconiosis in the United States

Abstract

Background: Severe coal workers' pneumoconiosis (CWP) is increasingly common, and sometimes requires lung transplantation.

Methods: Using Organ Procurement and Transplantation Network data, we updated the trend for CWP-related lung transplants, described CWP patients who have been waitlisted but not transplanted, and characterized the primary payer of medical costs for CWP-related and other occupational lung disease transplants.

Results: There have been at least 62 CWP-related lung transplants; 49 (79%) occurred in the last decade. The rate of these procedures has also increased. Twenty-seven patients were waitlisted but did not receive a transplant. Compared to other occupational lung diseases, transplants for CWP were more likely to be paid for by public insurance.

Conclusions: The increase in the frequency and rate of lung transplantation for CWP is consistent with the rising prevalence of severe CWP among U.S. coal miners. Effective exposure controls and identification of early stage CWP remain essential for protecting these workers.

Keywords: Organ Procurement and Transplantation Network; coal workers’ pneumoconiosis; lung transplantation; occupational lung disease.

FIGURE 1

Frequency of lung transplant in patients with a primary diagnosis at time of transplant of coal workers’ pneumoconiosis or pneumoconiosis unspecified, defined as a patient listed with a free-text diagnosis of pneumoconiosis without additional specification (top frame); frequency of lung transplant waitlist addition for patients with a diagnosis of coal workers’ pneumoconiosis or pneumoconiosis unspecified, as specified at time of waitlist addition (bottom frame), United States, January 1994-June 2017*