Beyond the Coal Mines: Evaluation of Institutional Lung Transplant Outcomes in Coal Workers' Pneumoconiosis Compared to National Outcomes in Non-Occupational ILD.

BACKGROUND: Coal workers' pneumoconiosis (CWP) is a progressive occupational lung disease caused by chronic inhalation of coal dust. Nationally, CWP accounts for approximately 1% of lung transplant indications, in contrast to nearly 60% attributed to non-occupational ILD. Due to its proximity to the Appalachian Basin, the University of Kentucky (UK) treats a higher proportion of CWP (ILD: CWP ∼3:1 vs ∼60:1 nationally). This study evaluates institutional post-lung transplant outcomes for CWP. METHODS: Lung transplants performed for CWP at UK between 2017 and 2025 were identified from an institutional database. Demographic and clinical outcomes including survival, length of stay (LOS), acute kidney injury (AKI), renal replacement therapy (RRT), primary graft dysfunction (PGD; grade 3), and airway complications were collected in accordance with institutional and IRB regulations. Data was analyzed using descriptive statistics. RESULTS: Among 23 CWP recipients, the mean length of stay was 39.8 days, with over half of patients hospitalized for more than 23 days. AKI occurred in 30.3% of patients, with 8.7% requiring RRT. PGD grade 3 occurred in 8.7%. Bronchial stenosis requiring dilation occurred in 8.7%. Post-transplant survival was 95.7% at 90 days and 86.4% at 1 year. CONCLUSIONS: Despite representing a rare indication nationally, CWP accounts for a substantial proportion of lung transplants in coal-mining regions. Outcomes in this cohort demonstrate survival rates comparable to ILD, but hospitalizations were significantly longer, suggesting unique perioperative or recovery challenges. These findings suggest that patients with CWP may have distinct peri‑ and post-transplant trajectories that warrant tailored management strategies.