title: Survival following lung transplantation for silicosis and other occupational lung diseases.
abstract: BACKGROUND
  Information is scant assessing outcomes in lung transplantation (LT) in advanced occupational lung diseases (OLD).
  
  
  OBJECTIVE
  To analyse survival after LT for OLD.
  
  
  METHODS
  Using data from the US Organ Procurement and Transplantation Network Registry (OPTN-R), we identified subjects aged ≥ 18 years transplanted for OLD from 2005 to 2010. OPTN-R selected referents of corresponding age, sex and body mass index (BMI) who underwent LT for other diagnoses were also identified. Post-LT survival time was estimated with Cox proportional hazard models. Baseline age, BMI, forced expiratory volume in 1 s, creatinine, lung allocation score, donor age, donor lung ischaemic time and transplant type (single versus bilateral) were included as covariates. Time-dependent covariates were used to model differences in relative risk over time.
  
  
  RESULTS
  Thirty-seven males underwent LT for silicosis (n = 19) or other OLD (n = 18) during the analytic period (0.5% of all LTs). For non-silicotic OLD, 6-month and 1- and 3-year survival estimates were 66, 55 and 55%, compared with the silicotic group (86, 86 and 76%) and referent group (89, 84 and 67%). During the first year post-transplant, those with OLD (silicosis and others combined) manifested an overall 2-fold increased mortality risk [hazard ratio (HR) 2.3, 95% CI 1.3-4.4; P < 0.05] compared to referents. In stratified analysis, this increased risk of death was restricted to those with non-silicotic OLD (HR 3.1, 95% CI 1.5-6.6; P < 0.01). Poorer survival was limited to the first year post-LT.
  
  
  CONCLUSIONS
  Subjects undergoing LT for OLD other than silicosis may be at increased risk of death in the first year post-transplantation.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco, CA 94143, USA. jon.singer@ucsf.edu
authors.forename: J P
authors.initials: JP
authors.lastname: Singer
authors.forename: H
authors.initials: H
authors.lastname: Chen
authors.forename: T
authors.initials: T
authors.lastname: Phelan
authors.forename: J
authors.initials: J
authors.lastname: Kukreja
authors.forename: J A
authors.initials: JA
authors.lastname: Golden
authors.forename: P D
authors.initials: PD
authors.lastname: Blanc
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D006801:Humans; D008171:Lung Diseases / Q000401:mortality*; D016040:Lung Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000401:mortality*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012829:Silicosis / Q000601:surgery; D015996:Survival Rate; D013997:Time Factors
references.citation: Rev Med Liege. 2009 Jul-Aug;64(7-8):373-6
references.pmid: 19777914
references.citation: J Formos Med Assoc. 1992 Sep;91(9):926-32
references.pmid: 1363397
references.citation: J Thorac Cardiovasc Surg. 1971 Jun;61(6):835-46
references.pmid: 4932557
references.citation: J Occup Environ Med. 2011 Aug;53(8):845-9
references.pmid: 21785367
references.citation: Ann Chir. 1992;46(2):105-9
references.pmid: 1605532
references.citation: Am J Transplant. 2006;6(5 Pt 2):1212-27
references.pmid: 16613597
references.citation: J Heart Lung Transplant. 2010 Jul;29(7):731-8
references.pmid: 20382034
references.citation: J Heart Lung Transplant. 2010 Sep;29(9):1026-33
references.pmid: 20558085
references.citation: PLoS One. 2009 May 25;4(5):e5689
references.pmid: 19479048
references.citation: J Heart Lung Transplant. 2010 Oct;29(10):1104-18
references.pmid: 20870165