Book Review

Liver Disease in Children

N Engl J Med 2007; 357:1878November 1, 2007

Article

Liver Disease in Children
Third edition. Edited by Frederick J. Suchy, Ronald J. Sokol, and William F. Balistreri. 1030 pp., illustrated. New York, Cambridge University Press, 2007. $185. ISBN: 978-0-521-85657-7

The rapidly expanding field of pediatric hepatology deals with a set of diseases that are vastly different from those that are addressed in the field of adult hepatology. The pediatric diseases are a varied mix of inborn errors of metabolism, congenital anatomic defects, genetic problems, autoimmune diseases, and acquired infections. In pediatrics, the age of the patient is extremely important when laboratory values, clinical presentation, and therapies are considered. The third edition of Liver Disease in Children covers these complexities with thoughtfulness and thoroughness in 41 chapters.

In the age of easy access to the latest information by means of the Internet, the purpose of a book needs scrutiny. Three features would make this book worthy of a substantial financial investment: it should cover all the key aspects of the field, it should offer a strong conceptual framework for teaching, and it should give state-of-the-art information in adequate depth.

The latest edition of Liver Disease in Children meets all three criteria. Most chapters are written by experts, and each chapter presents state-of-the-art information while steering away from issues that might have become outdated before the book went to press. There are notable changes in this edition. Among the new chapters are chapter 34, “Nonalcoholic Fatty Liver Disease,” and a new first chapter, “Liver Development: From Endoderm to Hepatocyte,” which gives an overview of the molecular embryology of the liver. Both chapters are well written and bring attention to important areas in pediatric hepatology. Nonalcoholic steatohepatitis is a newsworthy topic, and the data are presented judiciously — the importance of this burgeoning area of liver pathology is neither exaggerated nor underplayed.

The book identifies gaps in the current state of knowledge in the field. The molecular events in hepatic development open a window to embryologic malformations and differences in manifestations of disease in patients of various ages. The chapter on liver development draws attention to a number of recent discoveries in this field, such as the association of the Notch gene with Alagille syndrome and the link between HNF6 and VPS33B in embryology. The reorganization of some chapters, such as those that discuss iron metabolism, provides clarity. Chapter 8, “Laboratory Assessment of Liver Function and Injury in Children,” is clear and easy to read, and it covers various laboratory tests that are related to the liver. Last, the collection of color plates in the center of the book is a highlight of this edition.

The book admirably covers a vast amount of hepatology, but it only touches on liver transplantation. In the near future, many trainees in pediatric hepatology will complete examinations for joint qualification in pediatric hepatology and pediatric liver transplantation. These pediatricians must understand immunosuppressant agents, timing of post-transplantation complications, and factors that predict pretransplantation and post-transplantation outcomes. These areas, which are discussed minimally in this book, cannot be dealt with adequately in one chapter.

Since the publication of the first edition of Liver Disease in Children, it has been one of the core textbooks of pediatric hepatology. The third edition is up-to-date and has incorporated large amounts of new information. Once again, it is the essential pediatric hepatology textbook.

Barbara Haber, M.D.
Children's Hospital of Philadelphia, Philadelphia, PA 19104