Book Review

Medical Complications of Kidney Transplantation

N Engl J Med 2008; 358:98-99January 3, 2008

Article

Medical Complications of Kidney Transplantation
By Claudio Ponticelli. 425 pp., illustrated. Abingdon, England, Informa Healthcare, 2007. $229.95. ISBN: 978-0-415-41715-0

Medical Complications of Kidney Transplan tation is a wonderful reference that details the problems that can develop in recipients of kidney transplants: allograft dysfunction, cancer, infection, hematologic diseases, skin lesions, cardiovascular events, and musculoskeletal, ocular, and neurologic disturbances. It is a complete compilation of author Claudio Ponticelli's extensive experience and insight into the art of transplantation medicine, combined with a review of the medical literature on the subject. The book is easy to read, is nicely illustrated, and includes useful tables.

But even with all these positive attributes, there are several distractions. A medical book written by a single author will naturally contain biases and opinions. Bias comes not only from the author's clinical experience but also from associations with institutions, some of which may be a part of private industry, that fund his or her work. Thus, all medical books should include a page that lists the author's possible conflicts of interest, as is required in other forms of medical presentation. Although this is important for all books and publications, it is particularly so for books penned by one author.

Another problem with single-authored medical books such as this one is the extent of the author's knowledge and understanding of specific topics. An example in Ponticelli's book is the section on informed consent. In it he states that physicians must determine the motives of possible transplant recipients and donors. To the contrary, the policy at some institutions and programs is that it should not be the physician who makes these determinations, because of an inherent conflict of interest, and that instead — and especially in the case of living donors — the motives should be assessed by another capable professional.

The book would have been stronger if each chapter had listed information, as is exemplified by Table 1.1 in the book (a list of the number of cadaveric kidney donors per million persons by country). Details about the number of patients, the type of study design, the outcome, and the type of analysis would have clarified the value of the information, since most of the data on transplant recipients are from nonrandomized, uncontrolled, retrospective studies. Nowhere in this book is it explained for the nonexpert that the reported results are from programs with variable standards in which transplant recipients with different coexisting conditions were selected with the use of different evaluation algorithms and were treated with different medications after the transplantation.

A major omission from the book is a discussion of sexuality and reproduction for men and women who have undergone kidney transplantation, along with the changes in appearance that are wrought by treatments and the effect that these changes may have on compliance with treatment orders. The time of transition into adulthood, which is replete with emotional and financial difficulties, should also have been highlighted to place all physicians on the lookout for allograft dysfunction in patients in this age group.

Some other subject areas in which differences of opinion matter are tissue typing, crossmatch-positive transplantation, the management of infectious diseases, the evaluation of the donor for cancer, and the usefulness of cystoscopy before transplantation. More figures — such as one illustrating the effect of older donors and the duration of cold ischemia on the outcome of the transplantation — would have helped to put all the conflicting data into perspective. Sometimes a picture is worth more than words, especially when the sentences are full of numbers.

Ponticelli's book is easy to read, and for someone who is not completely versed in transplantation medicine, it is a nice review and covers vast territory. Despite its faults, it is also an excellent review for professionals in the field of transplantation.

Connie L. Davis, M.D.
University of Washington School of Medicine, Seattle, WA 98195
cdavis@u.washington.edu