Lung transplantation in silicosis, still rare

Silicosis is a relevant occupational lung disease with high morbidity and mortality. Despite the high prevalence of severe cases, in which lung transplantation (LTx) would be the only feasible treatment, the procedure is rarely performed due to technical difficulties, mainly due to the presence of calcified mediastinal and hilar lymph nodes hindering the correct visualization and separation of structures, and localized subpleural thickening increasing the risk of bleeding during lung removal. Aim: To describe the outcomes of LTx in six patients with silicosis. Methods: We evaluated data from six patients who underwent lung transplantation due to silicosis at two tranplantation centers, in Sao Paulo City, between September 2000 and February 2018. Results: Of the six patients, 5 were men (83,3%). Two patients (cases 1 and 2) had characteristics of accelerated silicosis; the remaining presented with chronic silicosis. Sandblasting accounted for 50,0% of occupational exposures. Five patients underwent single lung transplantation (83,3%) and one patient underwent bilateral lung transplantation (16,7%). Average FEV1 was 32,2% of predicted before surgery and 61,75% after LTx. Cardiopulmonary bypass (CPB) was used in 3 cases (50%). There was one perioperative death (16,7%). The most common late complications were bronchial stenosis (33,3%) and chronic lung allograft dysfunction (33,3%). The first-year survival rate after transplantation was 83,3%, similar to the survival rate for all causes in Sao Paulo LTx centers. Conclusion: LTx offers effective therapy for selected patients with end-stage silicosis. Given the high global prevalence and severity of cases of silicosis, which affect mainly younger population, LTx should be encouraged.