Published by Luis Alonso Pulpón and María G. Crespo Leiro, Editorial Médica Panamericana, Madrid, Spain; 2009: 267 pages, 59 tables, and 93 figures. ISBN 97884-9835-107-1.
Almost 42 years after the first heart transplant in humans performed by Dr Christian Barnard, the medical and social repercussions of this intervention can be seen in the statistics: More than 80 000 orthotopic heart transplants reported to the International Register and over 5000 patients to the Spanish Register. The great impact of this procedure on quality of life and time of survival of these thousands of patients shows the great importance of the publication of this first book on heart transplant in Spanish.
I wish to congratulate the authors on their initiative and the excellent acceptance achieved by the directors of the book, Dr Luis Alonso Pulpón, Head of the Heart Failure and Transplant Unit of the Clínica Puerta de Hierro (Puerta de Hierro Clinic), and Dr María G. Crespo Leiro, Head of the Heart Failure and Transplant Unit of the Complejo Hospitalario de A Coruña (A Coruña Hospital Complex), both outstanding experts in the field of heart failure and heart transplant.
The book includes the collaboration of 36 authors, all well-known experts in their fields, in their majority from different transplant centres in Spain, and some also from the United States and Argentina. It has 267 pages ordered in 15 chapters that make it possible to explore its contents in an agile and dynamic manner.
The Editorial Médica Panamericana edition, with great attention to detail, modern design and high quality printing and binding, is in two colours and has excellent colour plates.
As one reads it, it is possible to see the enormous amount of experience that has been gained in the field of heart transplant. These advances have meant that heart transplant is the best choice of treatment for heart failure in its terminal phase. It describes the changes that have taken place in receptor and donor selection criteria. Undoubtedly, due to the need for a greater number of donors, distribution models, forms of organ assignation in different countries and expanded criteria for the use of marginal donors are detailed.
The chapters on immunosuppression and rejection are extremely interesting; the advances achieved with immunosuppressor drugs and the management of the complications caused by their use are described in detail. Recently addressed subjects related to immunology and genetics are included, such as the possibility of using peripheral blood monocyte gene expression to identify patients with a low risk of acute cell rejection.
Risk factor control and care are very well addressed, as also early diagnosis, prophylaxis and treatment after transplant; factors which have undoubtedly improved the outcome of heart transplant over the last 30 years.
Heart transplant survival has improved, especially 6-12 months survival, whereas in the long term the development of graft vascular disease and neoplasias are the main causes of death. Both conditions are extensively addressed, including new drugs to reduce their incidence, in 2 updated chapters. The chapter that addresses comorbidities associated to transplants, such as renal dysfunction, hypertension, diabetes mellitus and dyslipidaemias, among others, includes pathophysiological and practical indications for their management and prevention.
There is a chapter on the fascinating subject of heart re-transplant, with indications and ethical considerations discussed. Current indications for cardiopulmonary transplant are re-addressed in view of the better results obtained with the lung transplant program.
Another chapter is especially dedicated to paediatric heart transplant, and challenging subjects are addressed such as induction of a state of graft tolerance to prevent complications of long term immunosuppression.
I wish to highlight that, although the subject of this book is a specific and complex therapy (heart transplant), it is of great interest not only for colleagues who carry out heart transplants, but also for cardiologists in general, general practitioners and all those who wish to improve patient survival and quality of life.