Outcomes after lung transplantation for patients with occupational lung diseases

Abstract

Occupational lung diseases (OLD) including silicosis, asbestosis, and pneumoconiosis progress to end stage lung disease requiring lung transplantation (LT). Prognosis and treatment of OLDs are poorly understood and a paucity of data exists regarding LT outcomes. Additionally, transplant operative complexity for patients with OLD is high. A single center retrospective review of all single and bilateral LT recipients between May 2005 and Oct 2016 was performed. Patients were grouped by OLD, and nearest neighbor matching was performed at a ratio of 1:3 cases to controls. Thirty cases were matched to 88 controls. Seventeen patients (57%) with OLD required intraoperative support with either extra‐corporeal membrane oxygenation (ECMO) or cardiopulmonary bypass (P = 0.02), and 5 (17%) required delayed chest closure (P = 0.05) which was more frequent than matched controls. In addition, operative time was significantly longer in patients with OLD (P = 0.03). Despite these factors, there were no significant differences in immediate post‐operative outcomes including mechanical ventilator support, post‐operative ECMO, and tracheostomy. Chronic lung allograft dysfunction and long‐term survival were also similar between cases and controls. OLDs should not preclude LT. The operation should be performed at experienced centers.

Hesperetin attenuates silica‑induced lung injury by reducing oxidative damage and inflammatory response

“…Together, these factors stimulate the proliferation of lung fibroblasts, the production of collagen and subsequently the formation of fibrosis (2,(12)(13)(14). However, previous studies have demonstrated that antioxidants, including vitamins, carotenoids and tannins provide protection against oxidative damage, and the negative regulation of inflammatory cytokines and/or the inflammatory signaling pathway may attenuate the progression of some pulmonary diseases (15)(16)(17)(18).…”

MiR-326 Inhibits Inflammation and Promotes Autophagy in Silica-Induced Pulmonary Fibrosis through Targeting TNFSF14 and PTBP1

“…However, there is no specific treatment for silicosis. The current treatment procedure involves removing the exposure of silica particles and symptomatic treatment . Accumulated evidence has revealed that the process of silicosis involves multiple signaling pathways, which regulate various cellular events, such as the persistent inflammatory response and structural destruction of lung tissues, and finally lead to respiratory failure .…”

Lung transplantation for interstitial lung disease

“…LTx is an option for several other ILDs including Langerhans cell histiocytosis [67], occupational ILD including silicosis [68,69], pleuroparenchymal fibroelastosis (PPFE) [70], chronic hypersensitivity pneumonitis [71] and sarcoidosis. Sarcoidosis is the most common of these less-frequent indications for LTx, accounting for 2.4% of worldwide transplants between 1995 and 2018 [1].…”

“…Evaluation of LTx candidacy is also similar, although surgical complexity can be increased in those with dense pleural adhesions. For example, one study compared outcomes of LTx for occupational lung disease versus other diagnoses, and demonstrated similar long-term survival, but a higher need for cardiopulmonary bypass and delayed chest closure in the occupational lung disease cohort [69]. PPFE, presenting either as its own entity or co-existing with other patterns of ILD, can be particularly challenging operatively, with dense adhesions often leading to thoracic contraction and increased bleeding risk [76].…”

“…PPFE, presenting either as its own entity or co-existing with other patterns of ILD, can be particularly challenging operatively, with dense adhesions often leading to thoracic contraction and increased bleeding risk [76]. LTx for PPFE or other disorders associated with dense pleural adhesions should be performed only in experienced centres [69,76].…”