The use of organ transplantation in lung disease is not new. Many of our patients who have been referred for lung transplantation have undergone extensive evaluations, and not all were candidates for this therapy. The types of diseases that bring patient to consider transplantation vary. The most common are COPD and pulmonary fibrosis, specifically, idiopathic pulmonary fibrosis (IPF), which is a progressive scarring disease of the lung. Not only is it important for the patients to be evaluated for the severity of their disease, but also for their ability to tolerate the surgery and participate in the post-operative care and follow up. These assessments are important from a number of standpoints, including the fact that there are a limited number of lungs that become available for transplant and the waiting list can be long.
There is an urgent need for biomarkers to help stratify patients with IPF by risk for lung transplantation allocation who have the same clinical presentations. One current observation of a common finding in blood samples may point the way to a simple method to help assess risk. A common blood cell called a monocyte may provide some information. In a recent study, elevation of the common monocyte count in the blood was associated with shorter transplant-free survival times. Therefore, it could potentially identify those patients with similar presentations that may need to be considered for transplantation earlier. The monocyte count is routinely obtained and is reproducible.