Book Review

Liver Immunology: Principles and Practice

N Engl J Med 2008; 358:1874-1875April 24, 2008

Article

Liver Immunology: Principles and Practice
Edited by M. Eric Gershwin, John M. Vierling, and Michael P. Manns. 486 pp., illustrated. Totowa, NJ, Humana Press, 2007. $169. ISBN: 978-1-58829-818-8

We enjoyed reading this book because it contains much useful information and many interesting insights into liver immunology. The topic is of great interest because of continuing advances in our understanding of chronic viral infection of the liver, autoimmune liver disease, and liver transplantation. The contributors to this book are mainly from North America and Europe, however, so a truly global representation of topics is lacking. Schistosomiasis, for example, should have received greater attention, and the reasons for the rapid progression of coinfection with HIV and hepatitis C to severe liver disease merit greater discussion.

In the foreword, Ian Mackay introduces the book with a perspective that is possible only from someone of his standing. Following this introduction, there are excellent chapters on liver fibrosis, transplantation immunology, nonalcoholic fatty liver disease, and the immunogenetics of autoimmune liver disease. However, some chapters constitute a collection of independent review articles, with an irksome variation in writing styles. It was disappointing to find so many grammatical errors in the text and accompanying tables.

Color-Enhanced Electron Micrograph of Hepatitis A Virus Particles.

The layout of the book is sensible, and the chapters are ordered logically. We might have placed discussions regarding disease recurrence after organ transplantation in their respective sections, though, since this would have yielded less repetition. We liked the chapter on hematopoietic stem-cell transplantation and the liver, but whether it should have been included in this book is debatable. Repetition is hard to avoid in a book of this kind; sometimes it helps to reinforce concepts, but at other times it is irritating to readers. Autoimmune liver disease is well represented, but there is considerable duplication in the discussions of autoantibodies.

Conversely, there was room for further discussion of the subtype of autoimmune hepatitis in which antimitochondrial antibodies are present. This condition could have been presented as a good example of the difficulties clinicians and scientists face when interpreting results of tests for autoantibodies that are apparently highly specific. The term “autoimmune cholangitis” was introduced in the context of children with autoimmune hepatitis, in whom perhaps 50% will have a cholangiopathy, but the observations related to autoimmune cholangitis and pancreatitis associated with elevated IgG4 levels should have had a greater presence in this book. Similarly, the major advances in animal models of primary biliary cirrhosis are not featured in this book as prominently as they should be. Additionally, there could have been better coordination of the two chapters on drug injury to the liver. In the sections on alcohol and acute liver failure, the authors and editors appear to have struggled to appeal to both clinicians and scientists, and we were left feeling that these sections were not polished end products.

Aesthetically, the layout is traditional and uninspiring, and the publishers were parsimonious with the use of color — certain figures cannot be appreciated well in black and white. In summary, this book is a good attempt to provide broad coverage of liver immunology, but it doesn't quite meet the mark. At a time when the worldwide burden of chronic liver disease (and hepatocellular carcinoma in particular) continues to grow, this book would have been stronger if it had a more international outlook.

Gideon Hirschfield, M.D., Ph.D.
Jenny Heathcote, M.B., B.S., M.D.
University of Toronto, Toronto, ON M5T 2S8, Canada
gideon.hirschfield@uhn.on.ca