Cardiac Allograft Rejection

Edited by G. William Dec, Jagat Narula, Manel

Ballester, Ignasi Carrió. Boston: Kluwer Academic Publishers, Boston; 2001: 434 pages.

ISBN: 0-7923-7329-4.

Cardiac transplant is still a new technique and, therefore, there is avid interest in books, treatments, and ideas regarding its many aspects. The book Cardiac Allograft Rejection, edited by Drs. Dec, Narula, Ballester, and Carrió, discusses with great clarity and scientific precision the immunotherapy of the allograft, clinical treatment of rejection, and new radionuclide methods for diagnosing and detecting graft rejection.

The originality of this book is noticeable from the beginning, where the artistic career of modernist Antoni Tàpies, whose artwork appears on the cover, is discussed.

The book is divided into 4 sections. The first section, entitled «Immunopathology of cardiac allograft rejection» covers the immunological and histocompatibility aspects that explain the rejection mechanism; the authors also describe, in a particularly interesting manner, the apoptotic mechanism that intervenes in the rejection process, as well as different strategies for bringing about graft tolerance. This section ends with a description of the types of hyperacute early rejection involved in xenotransplants.

The second section, which carries the title «Clinical aspects and the management of cardiac graft rejection», is of practical use for clinical professionals dedicated to the field of cardiac transplant. Both the subjects and their content are up-to-date, are of significant clinical application, and are useful for the day-to-day treatment of this type of patient. Chapter 12 is of particular interest as it draws important and useful conclusions regarding acute vascular rejection.

The third section analyzes «New methods for diagnosing graft rejection» and validates biopsy as the best, although not ideal, method. A review is also made of the biochemical-immunological methods and imaging techniques (anti-myosin antibodies) for the diagnosis of rejection. The second chapter in this section is especially interesting and of practical use as it thoroughly analyzes the echocardiography characteristics of the transplanted heart and the criteria that suggest rejection when this non-invasive technique is used. The last chapter of this section concerns the usefulness of cardiography magnetic resonance in the diagnosis of rejection when used to support biopsy and other non-invasive techniques.

The last section, called «Radionuclide imaging techniques for monitoring the occurrence of cardiac allograft rejection» deals with markers for the analysis of lymphocytes, cardiac cells, myocardial function, and specific intracellular components that may be altered by the rejection process. The text is interesting and up-to-date, and is therefore clear and instructional. In the last chapter of this section, the authors discuss strategies and plans of action in the face of cardiac allograft rejection diagnosed by anti-myosin antibodies, and the usefulness of this method for controlling the rejection after withdrawal of corticosteroids in transplant patients.

In addition to the scientific point of view, three other complementary aspects of this book should be mentioned: the tables and figures are well-chosen and explanatory; the references, in many chapters, are grouped by subject, making all the references on a specific aspect easily and quickly accessible; finally, the book contains a collection of high-resolution color photographs and diagrams that are particularly pleasing to the eye.

In summary, the book edited by Drs. G. William Dec, Jagat Narula, Manel Ballester, and Ignasi Carrió provides an opportunity to broaden and update our knowledge of the rejection of an allograft in cardiac transplant. The design, structure, and practical applications of this book make it one that should be part of the library of all professionals dedicated to the study of cardiac transplant.