Book Review

Thoracic Transplantation

N Engl J Med 1995; 333:1432November 23, 1995

Article

Thoracic Transplantation
By Sara J. Shumway and Norman E. Shumway. 481 pp., illustrated. Cambridge, Mass., Blackwell Science, 1995. $125. ISBN: 0-86542-285-0

In a figurative as well as a literal sense, transplantation of the heart is an idea that has long kindled the imagination of Eastern and Western societies alike. Lieh Tzu, the ancient Chinese historian, reported that approximately 100 years after Ezekiel wrote, “And I will replace your heart of stone with a heart of flesh” (Ezekiel 36:26), the eminent physician, Pien Ch'iao, performed an exchange of hearts between two persons to restore the equilibrium of their unbalanced yin and yang energies and used a mixture of traditional medications to ensure the operation's success. The foundations of modern cardiac transplantation were unequivocally established by the studies of Norman Shumway, who together with his daughter, has edited this multi-authored collection of contributions by his trainees and colleagues. The graphic yet anecdotal descriptions in the book illustrate Shumway's capacity to define problems and to stimulate his pupils to examine them, as well as his Herculean persistence in the face of monumental obstacles to translate the discoveries into medical practice.

The historical descriptions and the presentations of careful algorithms to guide clinical practice are two outstanding features of this book. Griepp and colleagues track the contributions of our American heroes — Carrell, Guthrie, Mann, Marcus, Neptune, and Webb — as well as the frequently overlooked contributions of the Russian Demikhov to the final development of heart and heart–lung transplantation. Shumway modestly recounts the important advances made by his pupils in the field of thoracic transplantation. Maddaus is to be congratulated on his lucid chapter on the history of lung transplantation, in which he discusses the importance of Haglin's observation that primates depend little on respiratory reflexes for ventilation, and describes Veith and Richard's meticulous bronchial and atrial anastomotic techniques as well as Cooper's elucidation of the adverse effects of corticosteroids and of rejection reactions on the tenuous bronchial circulation.

The book covers the full spectrum of cardiac-transplantation practice, from organ retrieval (as presented in chapters by Baldwin) and the donor-evaluation process (as chronicled by Allen) to the evaluation and treatment of recipients (as described in comprehensive chapters by Olivari, Frist, Stinson and Oyer, and Billingham and Berry). Unfortunately, the utility of the rest of the book as a manual for clinical practice is limited by the truncated nature of many of the other chapters.

The elegant introduction to the “ferocious process of transplant rejection” by Nossal is complemented by an “enlightened empiricism” in the excellent contribution by Bolman and colleagues, which perspicaciously analyzes strategies of clinical immunosuppression. Morris provides an erudite consideration of new investigational agents. In other chapters of the book, however, the mechanisms of action of currently approved drugs are incompletely or incorrectly described. Moreover, the book lacks an emphasis on the genetics, biology, and clinical implications of the HLA system, fails to report excellent results that have been achieved with cardiac-support systems other than the Novacor, and neglects to address innovative approaches to overcoming the present constraints of the transplant process, such as the palliative rather than curative nature of the outcome, as well as its labor- and cost-intensive nature.

Although this book does not forecast a direction for thoracic transplantation in the next millennium, its well-organized presentation of the field's triumphs makes it worthy of a place in the libraries of physicians and surgeons interested in organ replacement or in heart disease.

Barry D. Kahan, Ph.D., M.D.
University of Texas Medical School at Houston, Houston, TX 77030