[Lung transplantation for silicosis: a report of 5 cases].
OBJECTIVE
To investigate the selection of recipients, operative technique, and perioperative management of lung transplantation for silicosis.


METHODS
Lung transplantations (LTx) were performed for five end-stage silicosis in our hospital who were diagnosed in accordance with recommendations of the local Prophylactic Therapeutic Institution for Occupational Diseases. The chest roentgenogram and high resolution CT showed somewhat pulmonary interstitial fibrosis, pulmonary emphysema and massive opacities. The mean pulmonary artery pressure (mPAP) was > 30mmHg, NYHA III or IV. Two patients received thoracic surgery prior to LTx, one patient was ventilator-dependent. One patient received bilateral sequence lung transplantation (BSLT) under extracorporeal membrane oxygenation (ECMO) support. Four patients received single lung transplantation (SLT), 3 under ECMO support.


RESULTS
Patient five died of multiple organ failure on postoperative day 8, the remaining four patients were discharged from hospital. During follow up, patient three died of severe infection 7 month postoperatively, the remaining three patients were alive for 5 years, 3 years and 2 years respectively, and lived good quality of life, especially with lower mPAP and improved lung function. Although our patients suffered low-grade chronic rejection with the manifestation of bronchiolitis obliterative syndrome (BOS).


CONCLUSIONS
Lung transplantation is a viable option for patients with end-stage silicosis, providing acceptable quality of life and survival. Both SLT and BSLT are satisfactory approach for end-stage silicosis,and long-term survival requires further investigations.
Department of Thoracic Surgery, Affiliated Wuxi People's Hospital, Nanjing Medical University, Jiangsu Province 214023, China.
Wen-Jun
WJ
Mao
Jing-Yu
JY
Chen
Ming-Feng
MF
Zheng
Yi-Jun
YJ
He
Shu-Gao
SG
Ye
Feng
F
Liu
Ruo
R
Chen
Xing-Feng
XF
Zhu
D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D012829:Silicosis / Q000601:surgery*; D016896:Treatment Outcome