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Ann Thorac Surg 1998;65:1295
© 1998 The Society of Thoracic Surgeons
a Fredericksburg, Virginia, USA
Edited by Kenneth L. Franco, MD
Mount Kisco, NY, Futura, 1997
397 pp, illustrated, $89.00
ISBN: 0-87793-397-6
Review of recent books
Pediatric Cardiopulmonary Transplantation, edited by Kenneth L. Franco, MD, is a comprehensive text with 20 chapters contributed to by an impressive list of 33 authors, many of whom are internationally recognized for their legion contributions to the field. Of necessity, a technology applied in children that depended upon and evolved from its application in adults leans heavily on past and ongoing experiences in its adult precursor. However, as any accomplished clinician in pediatrics or its subspecialties will attest, children are, indeed, not small adults. Chapter 3, "Pathology of Heart and Lung Transplantation," and chapter 19, "Pulmonary Retransplantation," rarely, if ever, mention the pediatric population, its experience, or its special considerations. It is not clear from chapter 19 if any of the 42 candidates or 13 ultimate recipients of pulmonary retransplantation were children. Other chapters on graft vasculopathy and heart-lung transplantation, as well as the transplant registry chapters, shed little new light on the pediatric patients. Also omitted, perhaps overshadowed by the biochemical and surgical heroics of this transplantation science, is a chapter devoted to the psychosocial aspects of this special group of patients. Suicide, noncompliance, growth, education, and procreation are alluded to in passing in some chapters, but probably warrant consideration in their own rights.
Forgiving these minor transgressions, the remainder of the chapters, as well as the book as a whole, are outstanding, with some truly wonderful contributions both well written and excellently referenced. By far, David Kapelanski, MD, from San Diego writes the finest treatise on lung preservation I have ever read. It is truly a masterpiece to which all the other chapters aspire, and some come very close. Valluvan Jeevanandam’s chapter on pediatric myocardial preservation is also excellent. The series of chapters on lung transplantation, 12 through 17, are each significant contributions, concise and informative. Chapter 18 on obliterative bronchiolitis, admitted by all authors to be the single greatest challenge in pediatric pulmonary transplantation, culminates these. Indeed, for us to continue to offer a heroic and costly therapy, the 3-year survival of which ranges from 40% to 60% in our best centers, we must do better to understand the process that costs the lives of many of these truly brave and pioneering children. Actuarial freedom from obliterative bronchiolitis in the pediatric cohort is 37% at 3 years!
Another vitally important and well-written chapter is from the Children’s Hospital of Pittsburgh, by Doctors Michaels and Green, on infectious complications (better termed infectious issues) in pediatric heart and lung transplantation. For children, many of the keys to success are anticipation and prevention of infection, which are well addressed here.
A review of this text would not be complete without due recognition and appreciation of the extensive contributions, both in their contributed chapters and in their quality clinical work and exhaustive research, of the pediatric transplant groups at Loma Linda University Medical Center and Columbia University, New York.
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