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Doody's Review ServiceReviewer: Wael M Otaibi, DO (Washington University School of Medicine)
Description: This book describes the history, art, and science of kidney transplant, presenting the most current trends. The first edition was published in 2003.
Purpose: The purpose is to present the most current knowledge in the field of kidney transplant. The book begins with a review of the history of kidney transplant, focusing on outcome trends. Next, immunology of transplant is explained, starting with a general overview, and continuing with current concepts in T-cell activation and transplant tolerance. The next two chapters describe immunosuppression medications used for induction, maintenance, and to treat rejection. Two chapters then cover the evaluation of potential recipients as well as potential donors, addressing the issue of extended criteria donors, living donors, and some of the ethical issues concerned with expanding the donor pool. The book then describes current techniques in the surgical approach to the donor and recipient, and concludes with a review of the complications of kidney transplants. There have been many developments in the field since the first edition, including advances in immunosuppression, new concepts in rejection, and emerging issues regarding the expanding pool of potential recipients and the implications in terms of the availability of organs and the changing pool of donors. This book provides a good review of these issues, making them clear to both first time readers and those who are well versed and are looking for a concise description of the latest in the literature.
Audience: It is written for practitioners, including general practitioners, internists, nephrologists, and transplant surgeons. Nurses would benefit from reading it, as it would give them a general idea of the immunology of transplant, as well as the surgical procedures, which would be helpful in their care of patients both preoperatively and postoperatively. It also provides a brief overview of kidney transplant in a comprehensive way that would be suitable for medical students or residents.
Features: The book first covers the history of kidney transplant, and alludes to issues confronting the field now as well as in the near and long term future. Among the issues, it presents long term outcomes and issues of organ availability and shortage. A chapter discusses transplant immunology, giving a brief description of general immunological concepts and that of the transplanted organ. Humoral and cellular mechanisms of immunity and rejection are presented and current concepts in T-cell activation and tolerance are discussed. Chapters 3 and 4 present transplant pharmacology, briefly describing the different eras in the development of antirejection medication. A detailed description of the different regimens and medications that are used for induction, maintenance, and treatment of acute rejection follows. Desensitization is also discussed in these chapters. The next chapter presents the process of evaluation of the prospective transplant recipient, including the absolute and relative contraindications to transplant. Chapter 6 introduces the topic of organ donor selection and evaluation, exploring the different criteria for donors, factors affecting outcomes, the process of evaluation and procurement, and new trends in deceased-donor transplant, including extended criteria donors and donation after cardiac death. Living donor selection and outcomes are also presented. Lastly, controversial issues such as donor solicitation and payment for donation are discussed. Next is a concise description of the surgical procedures in kidney transplant. Presented are the different procedures for procurement from deceased as well as living donors, including open, mini open, and laparoscopic nephrectomy. A description of the donor operation is provided. This includes kidney transplant in the pediatric population, as well as combined transplant operations. The book then describes some of the surgical complications that may be encountered, and briefly presents the indications for and technique of transplant nephrectomy. The last two chapters deal with infectious and noninfectious complications of kidney transplant and includes a summary of the American Society of Transplantation's "Guidelines for the Prevention and Management of Infectious Complications of Solid Organ Transplantation." Classic timelines for the development of the different infectious complications are discussed, followed by a presentation of the different bacterial, fungal, viral, and parasitic infections, their pathological presentation, diagnosis, and treatment. Recommendations on vaccinations and strategies for safer living after transplant are also provided. The noninfectious complications of kidney transplant are explained, including the etiologies, natural history course, diagnosis, and management of cardiovascular disease, renal impairment, hematological complications, bone disease, and malignancy. The best part of this book is the clear presentation of immunological concepts and mechanisms. The chapters on pharmacology are particularly useful for readers who need to develop a solid background in these concepts. The tables, graphs, and illustrations are clear and informative, without too much narrative or complexity. One inaccuracy appeared on page 33, where there was a reference to a Table 4, which did not exist in the chapter.
Assessment: This book provides a quick and concise understanding of the history, art, and science of kidney transplant, giving readers a good appreciation of the history of kidney transplant, an understanding of the current state of the practice, and issues and challenges facing the transplant community. This edition is justified given all the advances in the field and the new challenges and issues seen since the previous edition, including organ shortage, issues of long term outcomes, and the ever changing and advancing field of immunology and immunosuppression.