Liver Transplantation: Clinical Assessment and Management

 

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Edited by James Neuberger, James Ferguson, and Phillip N. Newsome. Wiley-Blackwell; July 2013; 374 pp; $129.95.

The first successful liver transplant was performed by Dr. Thomas Starzl in 1967. Since this monumental accomplishment, there have been continued refinements in surgery and immunosuppression, but many problems remain. Unresolved issues concern early versus late referral, and criteria for donor acceptance and patient listing remain unsettled. There has been enormous progress in the use of immunosuppressive agents, but problems with rejection and side effects of medication continue.

The text consists of five parts, and includes 30 chapters written by 39 contributing authors and a forward by Dr. Thomas Starzl. The book is accompanied by a website that includes 80 surgical video clips and an extended chapter on surgical aspects of liver transplantation.

The initial chapters consider the general criteria for listing and prognostic models of liver transplantation. Subsequent chapters deal with criteria for listing patients with specific diseases. Additional chapters deal with management of patients on a transplant list, as well as assessment of patients with acute liver failure.

A major section considers the unresolved controversy regarding the selection of donors, recipients, and the allocation of available livers. The final 17 chapters are reserved for an in-depth review of the immune system, the physiology of rejection versus tolerance, and the management of postoperative complications of rejection, renal failure, ascites, drug interaction, bone disease, cardiovascular complications, and posttransplant malignancy. Other aspects of the posttransplant state, pregnancy, and lymphoproliferative disease are included.

Each chapter is preceded by an outline of key points and is followed by a list of suggestions for further reading. Tables are useful and add to the presentation. The index is excellent.

The editors should be complimented on this in-depth scholarly treatise on liver transplantation. It should certainly be read by the members of transplant teams. One criticism might be that the topics are very diverse and some—though important in the broader context of the transplant enterprise—may not be of interest to the practicing gastroenterologist and hepatologist. This is not a “how to” book nor a clinical manual, but a comprehensive survey of liver transplantation.