Book Review

Transplantation Immunology

N Engl J Med 1996; 334:671-672March 7, 1996

Article

Transplantation Immunology
Edited by Fritz H. Bach and Hugh Auchincloss, Jr. 409 pp. New York, John Wiley, 1995. $79. ISBN: 0-471-30448-4

There is a cartoon by Sidney Harris that is sufficiently well known as to have made its way onto T-shirts sold in mail-order catalogues of the Public Broadcasting System. It depicts two scientists standing at a blackboard covered with equations both to their left and to their right. Directly in the center, connecting these sets of equations, is the simple statement, “Then a miracle occurs.” One scientist points to the statement and remarks wryly, “I think you should be more explicit here in step two.” The attempt to be just a bit more specific about how organ transplants can be carried out successfully has generated at least five Nobel prizes in the field of transplantation immunology and has led investigators to new discoveries relevant not just to this field but also to autoimmunity and even atherogenesis. Because of the wide appeal of this area, many nascent physician-scientists strive to understand its increasingly complex set of postulates and dogma, which shifts into new directions at an extremely rapid pace. And as the field expands to encompass a progressively wider spectrum of underlying scientific disciplines, those already working in transplantation biology welcome periodic up-to-date commentaries. In the book reviewed here, Bach and Auchincloss have, in their own words, sought to produce a “single source that is comprehensive enough . . . and yet not so cumbersome that reading it is overwhelming.” Although there are great difficulties inherent in such a task, I am pleased to say that they have generally succeeded, in large part by collecting a series of chapters by notable workers in the field that can stand alone as syntheses of particular investigative areas.

The book begins with a review of histocompatibility antigens and with several chapters devoted to the application of broad immunologic principles to the specifics of transplantation, such as the role of the thymus, antigen presentation, and cellular and humoral immunity. These sections, and the book as a whole, are not for the neophyte. The authors assume that the reader has a background in immunology, at least in terms of language and basic principles, and that the book's role is to bring the reader up to date and to consider problems of transplantation in the light of advances in immunology. References for the material run up to about 1993, but since the authors are prime investigators in the field there appear to be no major gaps, even in 1995. The section on antigen presentation by Auchincloss is especially well conceived. It integrates intuitive teleology well, is not afraid to editorialize in a fair and intelligent manner, and clearly distinguishes hypothesis from fact. In any work that attempts to be less than encyclopedic, some areas will be left out. For example, I missed a discussion of “newer” histocompatibility regions (e.g., HLA-G).

The second section of the book, entitled “Clinical Transplantation,” deliberately does not explicate matters of patient care. It attempts instead to broaden the perspective of workers in the science or clinical application of the “usual” specialties of surgical transplantation, such as renal transplantation. A good summary chapter on the major immunity-related clinical problems common to all transplants is followed by reviews of pancreatic and bone marrow transplantation and new pharmacologic immunosuppressants. There are no chapters specifically devoted to liver, kidney, or heart–lung transplantation.

The book reaches its stride in the second half, which includes 10 chapters on “frontiers in transplantation.” These well-thought-out monographs take up induction of tolerance by such means as mixed chimerism, intrathymic transplantation, and monoclonal-antibody manipulation. The repetition and overlap among these chapters are actually welcome, since they permit one to consider similar material from different expert viewpoints and also allow each chapter to be read independently. I found the chapter on xenotransplantation to be especially timely and informative, since it provides a state-of-the-art review that integrates knowledge of the biology of soluble and cellular coagulation factors with the immune system. An understanding of this synthesis is likely to be of great importance for the future of this and other transplantation endeavors. Indeed, in part because of this chapter, Transplantation Immunology met one of my most important criteria for a book of merit — it disappeared off my desk for a few days into the hands of a postdoctoral student.

Brian Richard Smith, M.D.
Yale University School of Medicine, New Haven, CT 06510

Citing Articles (2)

Citing Articles

1. 1

   Bieke Lambert, Christophe Wiele. (2005) Treatment of hepatocellular carcinoma by means of radiopharmaceuticals. European Journal of Nuclear Medicine and Molecular Imaging 32:8, 980-989
   CrossRef

2. 2

   Nicholas N. Onaca, Marlon F. Levy, George J. Netto, Mark J. Thomas, Edmund Q. Sanchez, Srinath Chinnakotla, Carlos G. Fasola, Jeffrey S. Weinstein, Natalie Murray, Robert M. Goldstein, Goran B. Klintmalm. (2003) Pretransplant MELD Score As a Predictor of Outcome After Liver Transplantation for Chronic Hepatitis C. American Journal of Transplantation 3:5, 626-630
   CrossRef