Open AccessIndium kinetics in an indium exposed worker before and after bilateral lung transplantation
Author(s) -
Nakano Makiko,
Hirata Miyuki,
Hamasaki Makoto,
Tanaka Akiyo,
Nagata Asahi,
Kumazoe Hiroyuki,
Wakamatsu Kentaro,
Shiraishi Takeshi,
Omae Kazuyuki
Publication year - 2020
Publication title -
journal of occupational health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.664
H-Index - 59
ISSN - 1348-9585
DOI - 10.1002/1348-9585.12165
Subject(s) - indium , lung , lung transplantation , medicine , pneumoconiosis , lymph , pathology , transplantation , infiltration (hvac) , inhalation , chemistry , anatomy , materials science , organic chemistry , composite material
Background A male worker with indium‐tin oxide (ITO)‐induced pneumoconiosis underwent bilateral lung transplantation (LT). Methods Post‐LT histopathological investigations of the isolated lungs and hilar lymph nodes were performed and indium concentration in serum (In‐S) and serum Krebs von den Lungen‐6 (KL‐6) were tracked for 122 weeks. Results He has attained the ultimate treatment goal of > 2‐year survival. The main histopathological characteristics were pan‐lobular emphysematous change, interstitial fibrosis, and lymphocytic infiltration in the peribronchiolar/perivascular portions, and numerous cholesterol clefts and giant cells containing brown particles. These findings support the conclusion that the lung injury was caused by the inhalation of ITO. Metal element mapping and indium in the isolated lungs revealed that inhaled ITO particles in humans migrate to the lymph nodes. In‐S remained at remarkably high levels (≥30 ng/mL) and showed wide fluctuation with bimodality until 46 weeks after LT, but KL‐6 remained in the normal range for almost the entire period. The indium concentration in the donor's resection lung at 10 weeks after LT was 143.5 ng/g wet‐weight, which was only one one‐thousandth of the recipient's lung (161 µg/g wet‐weight). After 48 weeks of LT, the recipient's In‐S had gradually decreased; the biological half‐life was 1.2 years. These results clearly suggest that indium remaining in the recipient's tissues did not adversely influence the transplant donor's lungs. Conclusions The transplanted donor's lungs were not influenced by indium in the recipient's organs. Bilateral LT is thus an effective treatment option in severe indium lung disease cases.