Book Review

Heart Transplantation

N Engl J Med 2002; 347:2175-2176December 26, 2002

Article

Heart Transplantation
By James K. Kirklin, James B. Young, and David C. McGiffin. 883 pp., illustrated. New York, Churchill Livingstone, 2002. $229. ISBN: 0-443-07655-3

Heart Transplantation, a beautifully written, comprehensive monograph, sets new standards. The authors, long-term scientific leaders in the field, are optimally positioned for this task. Their book covers the topic in a consistent and carefully balanced way. Cardiac transplantation has rapidly evolved since the groundbreaking experimental work of Norman Shumway's group at Stanford in the 1950s and 1960s and the first transplantation of a human heart, performed by Christiaan Barnard on December 3, 1967, in Capetown, South Africa. Heart Transplantation captures every aspect of the subject, from the early experiments to the realization of a dream (which took its place in history alongside the landing on the Moon) and to contemporary practice.

The authors of Heart Transplantation intend to provide in-depth coverage, including historical background, information about basic mechanisms, and discussion of clinical outcomes in the care of patients with advanced heart failure. At the same time, they aim to facilitate orientation to the subject and readability for a diverse audience — the health care practitioner as well as the expert in cardiac transplantation.

Kirklin, Young, and McGiffin introduce us to the field by honoring the breakthrough work of Alexis Carrel, Charles Guthrie, Shumway, and Barnard, among others. In 1965, Shumway, generally considered the father of clinical heart transplantation, prophetically commented, “For successful homotransplantation in man, it would be necessary to legally deprive of life both the donor, a hopeless brain injury for example, and the host whose own heart has not yet stopped beating. Considerable social, moral, and legal reformation must precede any serious clinical application of a challenging laboratory experiment.” To establish the background for the main body of the book, there are sophisticated, easily understood introductions to transplantation immunology and the use of advanced statistical techniques for outcome research.

After presenting this background material, the book moves on to topics including “The Patient before Transplantation,” “The Transplanted Heart,” “Management of the Transplant Patient,” “Long-Term Outcome after Heart Transplantation,” and “Special Situations in Heart Transplantation.” Throughout, the reader will find hundreds of insightful comments and clinical recommendations based on the vast experience at the University of Alabama at Birmingham and the Cleveland Clinic Foundation. The strength of many of these recommendations is that they are based on the Cardiac Transplant Research Database, which in many respects is the best data set currently available. I would advise caution, however, about the degree to which results from centers of excellence represented in this data base can be translated to the average transplantation center. I would also advise caution about whether improved post-transplantation outcomes can be equated with gain in benefit for the individual patient in the absence of data on risk stratification with respect to the severity of heart failure at transplantation.

A special highlight of the book is its seamless, interdisciplinary approach combining cardiology, surgery, and basic science. Another outstanding feature is the absence of redundancy, achieved by systematic cross-referencing and authoritative, expert editing and writing. What makes this book particularly welcome is its consistency in style; the integration of text, tables, and figures; and the well-designed special-interest boxes with optional background information, which facilitate the flow of thought in the main text. The extensive reference list (comprising more than 5000 references) provides a wealth of suggestions for further in-depth reading. Heart Transplantation sets the new standard with which subsequent books on this subject will have to be compared.

Mario C. Deng, M.D.
Columbia University College of Physicians and Surgeons, New York, NY 10032
md785@columbia.edu