One-year lung transplantation outcomes for engineered stone countertop workers with silicosis at a single center in Southern California, 2019 to 2023

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Rationale In the past decade, growing industrial exposure to respirable crystalline silica from manufacturing engineered stone (ES) products has caused rapidly progressive, irreversible silicosis worldwide. Consequently, there has been a recent surge in lung transplants for ES silicosis but few reports of post-transplant outcomes. We compared perioperative and one-year post-transplant outcomes for silicosis and non-silicosis interstitial lung disease (ILD) recipients at UC San Diego Health (UCSD). Methods Using the electronic health record and United Network for Organ Sharing database, we identified seven patients with silicosis and 69 with non-silicosis ILD who underwent double lung transplantation at UCSD from 2019-2023. We compared pre-transplant, perioperative, and one-year post-transplant outcomes between groups. Results Recipients with silicosis were younger than those with non-silicosis ILD (43.1±9.9 vs. 59.3±7.1 years; p<0.001). All seven patients with silicosis were male, and six reported Hispanic/Latino ethnicity. All silicosis patients reported employment in the countertop industry using ES products. Prior to transplant, patients with silicosis had significantly lower mean percent predicted (PP) forced expiratory volume in one second (FEV1) (24.3 PP vs. 46.6 PP; p < 0.001) and forced vital capacity (FVC) (28.7 PP vs. 43.3 PP; p < 0.01) than patients with non-silicosis ILDs. Though ischemic times were greater for silicosis recipients, perioperative complications rates were similar. At one-year post-transplant, there were no differences in survival, allograft rejection rates, or pulmonary function tests. Conclusion Though reflecting a failure of prevention, lung transplantation should be considered as a therapeutic option for patients with end-stage silicosis from exposure to engineered stone.

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