Clinical outcomes and survival following lung transplantation for work-related lung disease: a single-center retrospective cohort study

Our plain-English summary of Clinical outcomes and survival following lung transplantation for work-related lung disease: a single-center retrospective cohort study, by C. Ju, Y. Yang, Q. Lian, et al (Journal of Occupational Medicine and Toxicology, 2023).

The study

• Authors: C. Ju, Y. Yang, Q. Lian, L. Wang, X. Wang, B. Wei, D. Huang, X. Xu, J. He
• Journal: Journal of Occupational Medicine and Toxicology
• Published: 2023;18(1):2
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Patients with work-related lung disease (WRLD) are at increased risk of death caused by severe lung tissue damage and fibrosis. This study aimed to assess the clinical outcomes of lung transplantation (LTx) for WRLD and compare the results of LTx between WRLD and idiopathic pulmonary fibrosis (IPF).

Methods: This single-center retrospective cohort study reviewed the clinical data of patients who underwent LTx for WRLD or IPF at our hospital between January 2015 and December 2021. Cumulative survival rates after LTx were estimated using the Kaplan-Meier method.

Results: The final analysis included 33 cases of WRLD and 91 cases of IPF. The 33 WRLD patients consisted of 19 (57.6%) cases of silicosis, 8 (24.2%) cases of coal workers' pneumoconiosis, 3 (9.09%) cases of asbestosis, and 3 (9.09%) cases of other WRLD. Pneumothorax as an indication for LTx was significantly more common in the WRLD group than in the IPF group (51.5% vs. 2.2%, P < 0.001). There was no significant difference in the 5-year cumulative survival rate between the WRLD patients and the IPF patients (66.6% vs. 56.7%, P = 0.67). There was no significant difference in the best performance of exercise capacity and lung function between the two groups at 1 year post-transplant.

Conclusions: LTx had similar survival outcomes and lung function for WRLD and IPF patients. Pneumothorax was the primary indication for lung transplantation in WRLD.

© 2023. The Author(s).

In plain English

This single-center retrospective cohort study in Guangzhou, China, reviewed adults given lung transplants for work-related lung disease or idiopathic pulmonary fibrosis (IPF). The Methods give transplants from January 2015 to December 2020; the abstract says December 2021. It analyzed 33 work-related lung disease patients and 91 IPF patients, all male. Of the 33, 19 had silicosis from artificial stone, 8 coal workers' pneumoconiosis, 3 asbestosis, and 3 disease caused by cement or mushroom spores. No separate results were given for the asbestosis patients. Before transplant, 17 of 33 (51.5%) had had a collapsed lung (pneumothorax), versus 2 IPF patients (2.2%). Bleeding into the chest after surgery was more common in the work-related group (30.3% vs 4.4%). Five-year survival was 66.6% (95% CI 48.8–84.4%) for work-related disease and 63.5% (95% CI 52.7–74.2%) for IPF, not a statistically significant difference. The abstract gives 56.7% for IPF. The authors concluded that post-transplant survival and exercise capacity were comparable. They also concluded that pneumothorax was the main transplant indication for work-related disease at their center. They noted the small single-center sample and missing lung-function data.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: single-center retrospective cohort study comparing lung transplant outcomes in work-related lung disease versus idiopathic pulmonary fibrosis
• Who was studied: 33 patients transplanted for work-related lung disease and 91 transplanted for IPF at the First Affiliated Hospital of Guangzhou Medical University, China. The Methods give the transplant period as January 2015 to December 2020, while the article's abstract says December 2021. Follow-up ran until December 2021 or death. All patients were male. Female IPF recipients were excluded, as were patients younger than 18 or older than 70.
• Exposure: The work-related lung disease group comprised 19 (57.6%) cases of silicosis caused by artificial stone, 8 (24.2%) of coal workers' pneumoconiosis, 3 (9.1%) of asbestosis, and 3 (9.1%) of other disease caused by cement or mushroom spores. No asbestos fiber types or doses were reported. The comparison group had idiopathic pulmonary fibrosis.
• Main results:
  • Before transplant, 17 of 33 (51.5%) work-related lung disease patients had at least one pneumothorax, and 8 (24.2%) had recurrent pneumothorax. Among IPF patients, 2 (2.2%) had spontaneous pneumothorax (P less than 0.001).
  • More work-related lung disease patients than IPF patients received single-lung transplants (84.8% vs. 63.7%, P = 0.024).
  • Hemothorax (bleeding into the chest) occurred in 10 of 33 (30.3%) work-related lung disease patients and 4 of 91 (4.4%) IPF patients (P less than 0.001). Primary graft dysfunction and ICU and hospital stays were comparable between groups.
  • Cumulative survival, work-related group vs. IPF group: at 1 year, 75.8% (95% CI 61.1–90.5%) vs. 87.9% (95% CI 81.2–94.6%) (P = 0.82). At 3 years, 66.6% (95% CI 48.8–84.4%) vs. 70.3% (95% CI 60.7–79.9%) (P = 0.83). At 5 years, 66.6% (95% CI 48.8–84.4%) vs. 63.5% (95% CI 52.7–74.2%) (P = 0.67). None of these differences was statistically significant. The article's abstract instead gives 56.7% for the IPF group at 5 years.
  • At 1 year, best 6-minute walk distance did not differ significantly (518 vs. 505 m, P = 0.65). Lung function was generally better in the IPF group, for example FEV1 62.1% vs. 79.4% (P = 0.001).
• The authors' conclusion: The authors concluded that pneumothorax was the primary indication for lung transplantation in work-related lung disease patients at their center. They also concluded that post-transplant survival and exercise capacity were comparable between the two groups, and that larger multicenter studies are needed to verify the findings.
• Limitations the authors state:
  • The study was single-center with a small sample size, so its findings should be interpreted cautiously.
  • High 5-year mortality left fewer surviving patients, which may bias the results.
  • The younger age and higher share of single-lung transplants in the work-related group may have affected survival and lung function results.
  • Many patients lacked lung function tests, which may reduce statistical power for lung function comparisons.

Topics

Medical terms in this study, explained in our Lexicon: Lung Transplant, Cohort Study, Fibrosis, Idiopathic, Pulmonary Fibrosis, Silicosis, Pneumoconiosis, Pneumothorax.

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