Long-term Outcome of Lung Transplantation in Previous Intravenous Drug Users With Talc Lung Granulomatosis J.G. Weinkauf, L. Puttagunta, R. Nador, K. Jackson, K. LaBranche, A. Kapasi, J. Mullen, D.L. Modry, K.C. Stewart, M. Thakrar, K. Doucette, and D.C. Lien ABSTRACT Talc lung granulomatosis results from the intravenous use of medication intended for oral use. Talc (magnesium silicate) acts as filler in some oral medications; when injected intravenously, it deposits in the lungs leading to airflow obstruction and impaired gas exchange. Allocation of donor lungs to previous intravenous drug users is controversial. After a careful selection process, 19 patients with talc lung granulomatosis have received lung allografts inour program. Long-term survival for these patients is excellent and our results suggest the previous use of intravenous drugs should not necessarily preclude lung transplantation. T ALC LUNG granulomatosis is a disease of intravenous (IV) drug users. 1 The granulomas form when drug users repeatedly inject themselves with aqueous suspen- sions of pharmaceutical preparations designed for oral administration. Talc (magnesium silicate) is used as filler in many medications intended for oral use. Talc is insoluble in blood; therefore, when it is injected intravenously it is mostly trapped in the lungs. Talc causes a foreign body granulomatous inflammation leading to interstitial fibrosis, airflow obstruction, and pulmonary arterial occlusion. 2 Pen- tazocine (Talwin) and methylphenidate (Ritalin) are the most common drugs of abuse in our geographical area. Typically, these 2 oral tablets are crushed, suspended in water, and simultaneously injected. This disease occurs less commonly in heroin addicts because heroin is usually mixed in soluble fillers such as quinine, lactose, or maltose. Talc lung granulomatosis is relatively common indication for referral to our center. Allocation of donor lungs to previous IV drug users is controversial, with little informa- tion on outcomes. We sought to determine the outcome of lung transplantation for end-stage lung disease as a conse- quence of IV drug use. METHODS This single-center retrospective, study included all patients who received lung allografts for talc lung granulomatosis in our program since 1986. Before assessment, a minimum 6-month period of continuous abstinence was required. At the time of transplant assessment, all patients were assessed by a social worker and a psychologist. Completion of a formal drug abuse program and letter of support from an addictions counsellor was required. All patients accepted for lung transplantation consented to maintain- ing their abstinence from nicotine, alcohol, and illicit drugs via signed contracts. All were subject to random drug screening before transplantation. Patients with HIV were not accepted. Patients with hepatitis C infection were considered for lung transplantation if they had no hepatitis C viremia, successfully completed hepatitis From the Department of Medicine (J.G.W., R.N., A.K., M.T, K.D., D.C.L.), University of Alberta, Edmonton, Alberta, Canada; Department of Laboratory Medicine (L.P.), University of Alberta, Edmonton, Alberta, Canada; Alberta Health Services (K.J., K.L.), Edmonton, Alberta, Canada; and the Department of Surgery (D.L.M., K.C.S.), University of Alberta, Edmonton, Alberta, Canada. Address correspondence to Justin G. Weinkauf, MD, Depart- ment of Medicine, University of Alberta, 2E4.39 8440 112 Street NW, University of Alberta Hospital, Edmonton, Alberta, Canada T6G 2B7. E-mail: justin.weinkauf@ualberta.ca Fig 1. Explanted lung with multiple talc granulomas. © 2013 by Elsevier Inc. All rights reserved. 0041-1345/–see front matter 360 Park Avenue South, New York, NY 10010-1710 http://dx.doi.org/10.1016/j.transproceed.2012.11.004 Transplantation Proceedings, 45, 2375–2377 (2013) 2375