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Lung Transplantation in Coal Workers PneumoconiosisLung Transplantation in Coal Worker Pneumoconiosis FREE TO VIEW

Enrique Diaz-Guzman, MD; Joseph B. Zwischenberger, MD; Charles W. Hoopes, MD
Author and Funding Information

From the Department of Internal Medicine-Pulmonology (Dr Diaz-Guzman) and the Department of Surgery (Drs Zwischenberger and Hoopes), University of Kentucky College of Medicine.

Correspondence to: Enrique Diaz-Guzman, MD, Lung Transplant Program, University of Kentucky, 740 S Limestone St, Lexington, KY 40536; e-mail: enriquedgz@uky.edu


Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr Zwischenberger currently receives grant monies from MC3 and the National Institutes of Health, receives royalties from Avalon for his patent for a double-lumen cannula, is a consultant to Novalung, and serves on an advisory board for Ikaria. Dr Zwischenberger is also a frequently invited speaker on the subject of lung disease and treatments for lung disease. Drs Diaz-Guzman and Hoopes have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;140(5):1387-1388. doi:10.1378/chest.11-1461
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To the Editor:

We read with great interest the article by Wade et al1 in a recent issue of CHEST (June 2011). The authors reviewed the records of 138 coal miners who were diagnosed with coal workers pneumoconiosis (CWP) and developed evidence of progressive massive fibrosis (PMF). The authors reported that several patients had a rapid progression of the disease (5-12 years) and reported 21 deaths (15%) in the cohort during the study period.

Although the morbidity and mortality associated with CWP has decreased in the last half century, recent reports indicate an increased incidence in the percentage of underground coal miners diagnosed with CWP.2 Moreover, the number of cases of PMF among miners too young to have been in the mines prior to passage of the federal coal mine health and safety legislation in 1969 has continued to increase, resulting in a rise in years of potential life lost before age 65 years.3

CWP is a major medical and legal problem in the Appalachian region, where Pennsylvania, West Virginia, Virginia, and Kentucky account for the majority of cases of CWP and PMF in the United States.2 In addition, reports suggest an increased disease severity, geographical clustering in eastern Kentucky and southwestern Virginia, rapid disease progression, and advanced disease in younger miners.4

Patients with CWP develop severe pulmonary physiologic derangements that result in significant morbidity and quality-of-life limitations. Common complications include severe airflow obstruction (COPD and emphysema) and pulmonary hypertension resulting from chronic hypoxemia and vasculopathy associated with PMF.5

Based on data from the United Organization for Organ Sharing6 as of October 1, 2010, occupational lung disease (including CWP) represents an uncommon indication for lung transplantation. To our knowledge, there are currently no available reports of long-term outcomes related to patients with CWP who undergo lung transplantation. We recently presented our experience with lung transplantation in patients with CWP.7 We reported eight patients with history of CWP who underwent single or bilateral lung transplantation. Overall, patients had no increased risk for perioperative morbidity or mortality resulting from the presence of PMF, and the 1-year and 3-year survival were similar to other indications for lung transplantation (Table 1). Given the high prevalence of CWP in the Appalachian region, we believe efforts should be made to increase awareness among the medical community to encourage the prompt referral of patients with CWP and PMF for transplant evaluation, particularly for those younger than 65 years of age.

Table Graphic Jump Location
Table 1 Lung Transplantation in Patients With CWP

Mean age of patients, 53±5 y; eight men; six unilateral transplants and two bilateral transplants. Bi-Lat=bilateral; CRX=chest radiograph; CWP=coal workers pneumoconiosis; ILO = International Labor Organization; L-SLT=left single lung transplant; PMF=progressive massive fibrosis; R-SLT=right single-lung transplant.

Wade WA, Petsonk EL, Young B, Mogri I. Severe occupational pneumoconiosis among West Virginian coal miners: One hundred thirty-eight cases of progressive massive fibrosis compensated between 2000 and 2009. Chest. 2011;1396:1458-1462 [CrossRef] [PubMed]
 
Coal workers’ pneumoconiosis in the United States: regional differences 40 years after implementation of the 1969 Federal Coal Mine Health and Safety Act [published online ahead of print May 19, 2011]. Occup Environ Med. doi:10.1136/oem.2010.063594.
 
Centers for Disease Control and Prevention (CDC)Centers for Disease Control and Prevention (CDC) Coal workers’ pneumoconiosis-related years of potential life lost before age 65 years-United States, 1968-2006. MMWR Morb Mortal Wkly Rep. 2009;5850:1412-1416 [PubMed]
 
Centers for Disease Control and Prevention (CDC)Centers for Disease Control and Prevention (CDC) Advanced pneumoconiosis among working underground coal miners in Eastern Kentucky and Southwestern Virginia. MMWR Morb Mortal Wkly Rep. 2007;5626:652-655 [PubMed]
 
Akkoca Yildiz O, Eris Gulbay B, Saryal S, Karabiyikoglu G. Evaluation of the relationship between radiological abnormalities and both pulmonary function and pulmonary hypertension in coal workers’ pneumoconiosis. Respirology. 2007;123:420-426 [CrossRef] [PubMed]
 
2009 Annual Report of the US Organ Procurement and Transplantation Network and the Scientific Registry of Transplant Recipients: Transplant Data 1999-20082009 Annual Report of the US Organ Procurement and Transplantation Network and the Scientific Registry of Transplant Recipients: Transplant Data 1999-2008 2009; Rockville, MD US Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, Division of Transplantation
 
Diaz-Guzman E, Hayes D, Mullett T, Bonell M, Maynard R, Kraman S. Lung transplantation in patients with coal workers pneumoconiosis. Am J Respir Crit Care Med. 2010;:181(A)-4317
 

Figures

Tables

Table Graphic Jump Location
Table 1 Lung Transplantation in Patients With CWP

Mean age of patients, 53±5 y; eight men; six unilateral transplants and two bilateral transplants. Bi-Lat=bilateral; CRX=chest radiograph; CWP=coal workers pneumoconiosis; ILO = International Labor Organization; L-SLT=left single lung transplant; PMF=progressive massive fibrosis; R-SLT=right single-lung transplant.

References

Wade WA, Petsonk EL, Young B, Mogri I. Severe occupational pneumoconiosis among West Virginian coal miners: One hundred thirty-eight cases of progressive massive fibrosis compensated between 2000 and 2009. Chest. 2011;1396:1458-1462 [CrossRef] [PubMed]
 
Coal workers’ pneumoconiosis in the United States: regional differences 40 years after implementation of the 1969 Federal Coal Mine Health and Safety Act [published online ahead of print May 19, 2011]. Occup Environ Med. doi:10.1136/oem.2010.063594.
 
Centers for Disease Control and Prevention (CDC)Centers for Disease Control and Prevention (CDC) Coal workers’ pneumoconiosis-related years of potential life lost before age 65 years-United States, 1968-2006. MMWR Morb Mortal Wkly Rep. 2009;5850:1412-1416 [PubMed]
 
Centers for Disease Control and Prevention (CDC)Centers for Disease Control and Prevention (CDC) Advanced pneumoconiosis among working underground coal miners in Eastern Kentucky and Southwestern Virginia. MMWR Morb Mortal Wkly Rep. 2007;5626:652-655 [PubMed]
 
Akkoca Yildiz O, Eris Gulbay B, Saryal S, Karabiyikoglu G. Evaluation of the relationship between radiological abnormalities and both pulmonary function and pulmonary hypertension in coal workers’ pneumoconiosis. Respirology. 2007;123:420-426 [CrossRef] [PubMed]
 
2009 Annual Report of the US Organ Procurement and Transplantation Network and the Scientific Registry of Transplant Recipients: Transplant Data 1999-20082009 Annual Report of the US Organ Procurement and Transplantation Network and the Scientific Registry of Transplant Recipients: Transplant Data 1999-2008 2009; Rockville, MD US Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, Division of Transplantation
 
Diaz-Guzman E, Hayes D, Mullett T, Bonell M, Maynard R, Kraman S. Lung transplantation in patients with coal workers pneumoconiosis. Am J Respir Crit Care Med. 2010;:181(A)-4317
 
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