Lung and Heart-Lung Transplantation

Twenty-six and twenty-four years have passed since the first successful human heart-lung transplantation and the first successful human lung transplantation. Since then over 2,500 heart-lung transplant and 22,000 lung transplant procedures have been performed worldwide. Lung and heart-lung transplantation have become established therapies for patients with advanced lung disease. The annual volume of lung transplant procedures has continued to increase, with a total of 1,406 lung transplant procedures and 35 heart-lung transplant proceduresperformed in theUnitedStates in2005, reported by the United Network for Organ Sharing. The expanding population of posttransplant patients and the increasing national and international availability of lung and heart-lung transplantation for patients with advanced disease support the need for education about these procedures. Volume 217 of the Lung Biology in Health and Disease series, Lung and Heart-Lung Transplantation, is a comprehensive text that covers virtually all aspects of lung and heartlung transplantation. The broad spectrum of topics covered, and the juxtaposition of historic and current clinical management review with discussion of basic science and immunology support this text’s relevance and value as resource for all individuals involved in lung or heart-lung transplantation. Transplant physicians, nurses, medical personnel, and basic scientists will find this text informative. This book has 37 chapters, by an international panel of 75 contributing authors. Individual chapters include an overview introduction and are organized into subsections that facilitate easy access to specific information. The chapters are grouped into 10 parts, which focus on specific clinical aspects of lung and heart-lung transplantation. Part I provides an overview of lung and heart-lung transplantation, and focuses on the history and current outcomes. Part II details transplant immunology. These essential basic-science-oriented chapters provide an understanding of the mechanisms and problems underlying allograft rejection and tolerance. Part III consists of 8 chapters on diseasespecific aspects of transplantation, including disease management, referral criteria, and post-transplant management concerns and complications. There are chapters on chronic obstructive pulmonary disease, cystic fibrosis, pulmonary arterial hypertension, interstitial lung disease, Langerhans cell histiocytosis, lymphangioleiomyomatosis, pediatric transplantation, living lobar transplantation, and heart-lung transplantation. There is substantial variation in the depth of material covered in this section. The chapters on chronic obstructive pulmonary disease, interstitial lung disorders, Langerhans cell histiocytosis, and lymphangioleiomyomatosis provide in-depth reviews of pre-transplant disease management and prognosis, as well as disease-specific posttransplant concerns. The other chapters in this section are less detailed. Part IV addresses organ allocation in the United States, Europe, and Australia. The lung allocation scoring system recently adopted by the United Network for Organ Sharing is discussed, as are approaches to organ preservation and expansion of the pool of utilizable donor organs. Part V provides an excellent overview of agents used for immunosuppression after transplantation, and discusses potential future approaches. The 3 chapters in this section review the mechanisms and toxicities of these agents and summarize the limited clinical data on the use of various agents in lung transplantation. Part VI covers allograft complications, including primary graft dysfunction and airway complications. Part VII consists of 7 chapters that focus on infectious complications. Viral, fungal, bacterial, and mycobacterial infections are thoroughly covered, and the discussions include relevant references to experience in nonpulmonary solid-organ transplant settings. Parts VIII and IX address acute and chronic rejection and include discussions of pathogenesis, histology, and clinical manifestations. Clinical manifestations and management of acute rejection and obliterative bronchiolitis are discussed in close proximity to histologic and pathophysiologic correlations. The depth and completeness of discussion in these sections are noteworthy. Part X covers long-term complications of lung transplantation and immunosuppression. The content and detail are quite variable in this section, which covers a limited spectrum of disorders. Cardiac, lipid, and atherosclerotic disorders are discussed in detail, as are lymphoproliferative disorders. Metabolic bone disease is discussed briefly. There is no discussion of renal complications, neurologic complications, gastrointestinal complications, or nonlymphoproliferative malignancy. Tabular and graphical data summaries are clearly presented. However, the quality of the photographs is limited. Bronchoscopy, radiology, and histology are essential tools for the care of lung and heart-lung transplant patients, and the value of this book would have been enhanced by better photographs. The radiographs are compromised by poor resolution and diminutive image size throughout the text. The histologic and bronchoscopic photographs, reproduced in a similar manner, would have been of much greater value if printed in color with greater resolution. Whenever possible, the authors referenced and summarized pertinent available clinical outcomes studies. However, the paucity of randomized controlled studies in the field of lung transplantation must be noted. The text would have been improved by discussion of current limitations and future directions in outcomes research. In summary, Lynch and Ross have done an excellent job in assembling and organizing a single text that covers the major areas of lung and heart-lung transplantation. Though some of the topics included could have been covered in greater depth, and a few other topics could have been included, the comprehensive breadth and content of this textarecommendable.Thematerial covered in Lung and Heart-Lung Transplantation is detailed and up to date. It provides both essential background and in-depth dis-