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The prevalence of coal workers' pneumoconiosis (CWP) in U.S. coal miners has increased, and severe presentations are increasingly common.We describe trends in lung transplantation during 1996–2014 for recipients with a primary diagnosis of CWP or pneumoconiosis unspecified, and we summarize recipient characteristics and estimate survival.A total of 47 transplants were included; nearly three-quarters were performed during 2008–2014. All recipients were male, 96% were white, and the mean age was 56 years. Mean FEV1% was 35%; mean FVC% was 53%. Mean time on a waitlist was 155 days, and 60% of transplants were bilateral. Median survival was 3.7 years.These transplants reflect the use of a scarce resource for an entirely preventable disease, and highlight the need for enhanced efforts to reduce coal mine dust exposures. Am. J. Ind. Med. 59:175–177, 2016. Published 2016. This article is a U.S. Government work and is in the public domain in the USA.