Cardiac Transplantation. The Columbia University Medical Center/New York-Presbyterian Hospital Manual
Edited by Niloo M. Edwards, MD, Jonathan M. Chen, MD, Pamela A. Mazzeo. Humana Press Inc., 2004.
The field of heart transplantation has consolidated its position in late stage heart failure therapeutics for over 3 decades. Yet, the evolution of management in this field has largely been experientially driven by the anecdotal observations from high volume centers that define quality in this area. Furthermore, comprehensive ‘cradle to grave’ guidelines for evaluation and treatment of the heart transplant recipients have not been consistently and contemporaneously updated. Thus, a concise and practically oriented manual emanating from one of the country's largest heart transplant programs is a welcome addition to aid smaller centers in evaluating and refining their own patient management algorithms.
The book consists of 12 chapters that deal with appropriateness of listing criteria, selection and management of donors, direct attention toward UNOS policies, discuss issues in surgical techniques, specify immunosuppressive regimens used along with various aspects of the post-operative management and evaluate the common difficulties encountered in the post-operative management of these individuals. There is even an entire chapter devoted to the specific unique aspects of the pediatric heart transplant recipient, and other chapters dealing with surgical alternatives to transplant and mechanical circulatory support. Thus, within the space constraints of this series, the editors appear to have succeeded in delivering a well-packed compendium to guide therapy for heart transplantation. One of the critiques of this book is in the fact that there is heterogeneity in the writing styles and specificity of the messages conferred in the various chapters. Thus, for example, the chapter on donor selection and management is succinctly well written in a format of questions and answers, as a clinician should encounter during the evaluation process. Similarly, specific recommendations are provided in various other chapters such as in areas for listing and delisting of transplant candidates, coordination of the transplant process, and protocol immunosuppression regimens are provided. On the other hand, some areas are rather devoid of specific management recommendations and do not entirely do justice to the reader. For instance, one would like to know exactly what the institutional protocol is for dealing with post-transplant lymphoproliferative disorders, malignancies and post-transplant vasculopathy. One of the areas, which could have been emphasized, relates to the definition of optimal medical therapy prior to consideration of transplant and during maintenance of listing. The role of percutaneous devices like resynchronization pacemakers and implantable defibrillators would have been nice to at least merit a brief discussion. Finally, as the editors also admit, aspects of psychosocial and physical rehabilitation are important and deserve inclusion, but such omissions are essential characteristics of concise volumes that limit allowed space. One interesting feature of this handbook is the accompanying e-Book CD-ROM that can be viewed on a computer but is limited in its scope that it can only be used on a single computer and does not allow document portability.
This compendium is designed for clinicians and in that regard does optimal justice. In my opinion, this volume will be received well by those engaged in the field of heart transplantation including trainees, clinicians and non-clinicians alike. Even experienced clinicians will find this volume an easy refresher.
