Cardiovascular Diseases and Liver Transplantation edited by Zoka Milan

Cardiovascular Diseases and Liver Transplantation , edited by Zoka Milan . Nova Science Publishers , 2011 .

Medicine is a science of uncertainty and an art of probability. William Osler

While there is much that is uncertain about the management of cardiac disease in the context of liver transplantation, this book is an admirable undertaking that informs us on the topic. This subject will undoubtedly receive increased attention in the future due to the aging of liver transplant (LT) candidates.

Even now, cardiac morbidity and mortality is common among LT candidates and recipients, so it is surprising that this is one of the first books to appear on this topic. The work, of approximately 300 pages, is formatted into chapters on discrete and expected topics such as coronary artery disease and LT, valvular heart disease and LT, pulmonary hypertension and LT, and hepatopulmonary syndrome. Additional chapters focus on less common topics, for example, hypertrophic obstructive cardiomyopathy and the cardiac consequences of transjugular intrahepatic portosystemic shunt placement. Given the breadth of the 17 chapters, the book covers the subject of cardiac disease in the LT population comprehensively.

The primary limitation lies in the lack of prospective trials in the LT population for many, if not most, areas. As a result, the chapters’ authors appropriately turn to data from nontransplant populations, or less compelling levels of evidence including descriptions of their own institution's approach. Nonetheless, this is the state of the art, and the authors consistently acknowledge the level of evidence leading to their recommendations.

The authors’ diagnostic, monitoring and treatment recommendations, whether based on trials or simply expert opinion, are invaluable for practitioners caring for patients undergoing liver transplantation. This book conveniently places an exhaustive amount of information at the readers’ disposal. One could question the need for chapters in areas where no LT-specific data exist. For example, scant data exist regarding how to manage valvular disease in the LT candidate. However, given that LT professionals are called upon to manage patients with such conditions, expert opinion is of benefit. And that opinion is placed within the context of patients with end-stage liver disease, where the baseline hyperdynamic state may impact treatment decisions.

Figures and tables are not prevalent, and those that are included are of inconsistent quality and formatting. The substance is clearly the text, which is generally well written, insightful and well referenced. The chapter bibliographies are particularly noteworthy; they are thorough and uniformly up-to-date. The international compilation of authors is refreshingly multidisciplinary and includes prominent experts in the field. Anesthesiologists comprise about a third of the authors, while cardiologists, surgeons, hepatologists, an oncologist and a radiologist round out the contributors. A minor issue is that several authors’ specialties are left undefined, with their affiliation attributed to various “liver units” or “transplant programs.”

Despite some minor shortcomings, this book fills a considerable void by providing an expansive treatment of the topic of cardiac disease within the setting of liver disease. Each chapter's depth exceeds the usual discussion of the corresponding topic in standard textbooks. Cardiovascular Diseases and Liver Transplantation is an indispensable starting point for clinicians who screen liver disease patients for transplant suitability, and monitor and treat their cardiovascular disease at the time of transplantation.