Ann Thorac Surg 2003;75:421
© 2003 The Society of Thoracic Surgeons
Review of recent books
Heart transplantation
By James K. Kirklin, MD, James B. Young, MD, and David C. Mcgiffin, MD, 2002, London, England, Churchill Livingstone, Inc, 650 pp, illustrated, $229.00, ISBN: 0443076553
Bartley P. Griffith, MDa
a Baltimore, Maryland, USA
This text is the best of its kind. The reason it works so well is that it is a comprehensive text from a single center that works cohesively to explain history, science, and procedure and outcomes in cardiac transplantation. I am jealous of the Alabama group for their thoughtfulness in putting this together and of Jim Young for his strong contributions based upon his lifelong dedication to the medical therapy of those afflicted with end-stage heart disease. This book literally drew me in. I have, over a period of more than 25 years, read most of the chapters and short referenced texts on cardiac transplantation. None of them "hit the spot" as this one did. The editors have included authors of great experience who again fit well into the whole of the textbook, providing the reader with a continuity of style and approach that is nonrepetitive and certainly builds throughout. This text is very readable for nurses, administrators, surgeons, residents, coordinators, and even in some sense patients. As I read through each chapter, I attempted to be critical relative to the length of the chapter, the topics it covered, and its currency. I literally found no objections. I generally learned a great deal from each chapter in spite of the topic. I found myself back in college days reviewing statistics and math presented in Chapter Three entitled "Methodology for Clinical Research in Cardiac Transplantation." This chapter, of course, while bracketed around transplantation is valuable for all medical practitioners, and especially surgeons, who deal with rates of survival, comparison groups, cohort studies, etc. I found that the data were presented in an extremely clear way and one that, with a few repeated readings, was easy to remember.
"Immunosuppresive Modalities," Chapter 13, is a very important chapter dedicated to an evaluation of various immunosuppressive medications, their interactions, and their overall application in cardiac transplantation. This chapter is jam-packed with clinically relative information and a must for those involved in the care of these patients. The old days of a cookbook of non-varied immunosuppressive therapies good for all patients is probably in the past. Various medications are now available, each with their own toxicities, so that a variety of approaches should be undertaken based on the patient’s needs and responses. This chapter does a good job at introducing the clinician to the basics. One slight omission appears to be the important area of drug interaction that invariably affects all of our recipients at one point or another. It would have been helpful if the Immunosuppressive Modalities chapter would have included a bit more in the clinically relevant area of multiple drug use and multiple drug interactions. Chapter 15 discusses infections after heart and lung transplantation, and again hits the mark in terms of being an exhaustive reference for practitioners. It is especially useful as a roadmap for potential therapy and prophylaxis, and it appears to me to be especially good in the area of cytomegalic virus. Cytomegalic virus continues to be a problem, but with preemptive monitoring and new oral antibiotics it may evolve to a less threatening problem.
In summary, this is a reference text that needs not only to sit on the shelves of all practitioners interested in heart transplantation, but also needs to be read in its entirety many times. It is an example of three authors who have dedicated much of their lives to this area and who have recruited first-rate contributors to help those of us toiling in this field to understand a little bit better how to help the patients who are so much in need. We as a specialty should be thankful that so much time and effort was put forward by those responsible for this exemplary text.
