From the New England Journal of Medicine, March 11, 2004
The year 2003 marked not only the 50th anniversary of the discovery of the structure of DNA but also the 50th anniversary of the first description of invasive aspergillosis as an opportunistic infection. The publication of this report by Rankin in the British Medical Journal (1953;1:918-919.) ushered in a new era in the study of infectious diseases, that of the immunocompromised patient and opportunistic infections. A year later, syngeneic renal transplantation was achieved, with long-term survival, and bone marrow transplantation was first attempted in 1957. Thus began a new subspecialty -- transplantation medicine. The frequency and severity of numerous infections in the era before the common use of cyclosporine were such that transplantation was extremely risky, except in identical twins. The introduction of cyclosporine in 1980 and less-intensive immunosuppression abrogated the majority of these risks, and the modern era of transplantation was born. Approximately 500,000 transplantation procedures are undertaken each year around the world; slightly more than 50 percent are renal transplantations. (Figure) The diversity and complexity of the problems with infection inherent in transplant recipients are discussed in detail by the multiple authors of this excellent book. The editors of Transplant Infections have assembled a remarkable, international group of experts who describe the issues related to infection in solid-organ transplantation, hematopoietic stem-cell transplantation, and xenotransplantation. Epidemiology, clinical presentation, diagnostic approach, and therapy are addressed for each clinical syndrome and pathogen in each setting. This format can be duplicative; however, it is also important because the approach to management differs somewhat among types of transplantation. In some circumstances, surgical approaches are required, and these are also described in a scholarly but not overly technical way. The issues involved in reoperation are only touched on. Although several pediatric specialists have contributed to the book, no chapter is devoted solely to children. The practice of high-quality transplantation medicine is most certainly a multidisciplinary effort requiring a broad range of skills and knowledge. This book illustrates that requirement. The book uses the concepts of the "net state of immunosuppression" and its cousin, the "net state of tolerance," but perhaps because immune function is dynamic and difficult to measure with simple tests, there is little discussion of a practical means of assessing either, leaving the reader unsatisfied. The severity of complications is the chief reason why more allogeneic stem-cell transplantation procedures are not undertaken; better regimens for immunosuppression are required. Novel approaches, such as "mini transplantation," appear to avoid many of the early complications but may cause more trouble later. One of the challenges for the editors of this book was how to discuss the potential for infection after use of new biologic agents that may be used to treat rejection. Another was the recent introduction of two new antifungal agents -- caspofungin and voriconazole. There has been very little use of caspofungin in the context of transplantation because of a possible interaction with cyclosporine, and that cloud of uncertainty had not been lifted by the time this book went to press. With regard to voriconazole, a large randomized study of invasive aspergillosis confirmed its superiority to amphotericin B, but few solid-organ transplant recipients were included in the trial. There is limited experience in the use of voriconazole along with cyclosporine and tacrolimus (a combination of sirolimus and voriconazole is contraindicated). These ongoing issues meant it was difficult for the authors to be clear about the part these drugs may play in the management of transplant recipients who have fungal infections. None of the authors systematically address the issue of infections that can occur many years after transplantation. Anatomical abnormalities, aging organs, and long-standing rejection problems often transpire together to produce complex clinical situations. Examples include recurrent diverticulitis, lung abscesses, and recurrent cytomegalovirus disease in the context of chronic graft-versus-host disease. However, the principles of and management approaches to these problems are described in the book. Overall, this book is a hugely valuable resource to those who manage patients who are undergoing transplantation. David W. Denning, M.B., B.S.Copyright © 2004 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.

From Book News, Inc.
Immunocompromised individuals pose special problems in transplant management, in both bone marrow and solid organ transplantation. Bowden (pediatrics, U. of Washington School of Medicine, US), Ljungman (hematology, Huddinge U. Hospital, Karolinska Institute, Sweden), and Paya (immunology, Mao Medical School, US) present an expanded text on issues related to such problems, providing increased attention to the setting of specific transplant organs and greater attention to viral infections, endemic mycoses, and parasitic infections.Copyright © 2004 Book News, Inc., Portland, OR

Book Info
Univ. of Washington School of Medicine, Seattle. Discusses the management of infectious complications occurring specifically in individuals undergoing transplantation, whether hemopoietic stem cell transplantation, or solid organ transplantation. Features new research in fungal and viral complications. Previous edition: c1998. DNLM: Transplants--adverse effects.

ANNOTATION

The book contains black-and-white illustrations.

FROM THE PUBLISHER

A major portion of the book focuses on specific bacterial, viral, and fungal infectious agents. For each infectious agent, the text explains the specific risks and patterns of infection in hematopoietic stem cell transplant settings and different solid organ transplant settings. The contributors weigh the benefits and risks of various prophylactic and therapeutic strategies and recommend appropriate options. The final section describes immune reconstitution strategies for prevention and treatment of infections.

SYNOPSIS

Immunocompromised individuals pose special problems in transplant management, in both bone marrow and solid organ transplantation. Bowden (pediatrics, U. of Washington School of Medicine, US), Ljungman (hematology, Huddinge U. Hospital, Karolinska Institute, Sweden), and Paya (immunology, Mao Medical School, US) present an expanded text on issues related to such problems, providing increased attention to the setting of specific transplant organs and greater attention to viral infections, endemic mycoses, and parasitic infections. Annotation ©2003 Book News, Inc., Portland, OR

FROM THE CRITICS

Daniel C. Brennan

This monograph is structured according to infectious agent rather than to bone marrow or specific organ transplant. This provides a comparison and contrast between the two types of transplantation that I found to be extremely helpful and complementary. The purpose is to offer a comprehensive review of epidemiology, diagnosis, and management of opportunistic infections in bone marrow or solid organ transplant patients. This book is written for the medical community at large, not only for transplant physicians and surgeons but for primary care physicians as well. The treatment of viral disease in transplantation is particularly comprehensive and up-to-date. The unique feature is the dedication to transplantation that provides solid recommendations for dose and duration of treatment. This differentiates it from other texts that have treated infections disease in all immunocompromised hosts, including HIV patients, and made it more difficult to obtain specific recommendations for organ transplant recipients who have infections. The specificity of the recommendations make it quite useful for those who are not infectious disease specialists or do not primarily treat transplant recipients. The discussion of the basic bacteriology or virology of each infectious agent is somewhat limited. However, I find this is not a primary shortcoming; in fact, it allows for a more practical focus. If there were any shortcomings, perhaps the discussion of atypical mycobacteria and fungal infections is a bit limited for my own desires given my perception of the increasing incidence of these types of infections in transplant recipients under current immunosuppressive regimens. This is a very useful andreadable treatment of infectious disease in bone marrow and solid organ transplant recipients. I was able to read it cover-to-cover and I found much practical information and very little duplication. I strongly recommend it for anyone who treats or follows bone marrow or solid organ transplant recipients.

Doody Review Services

Reviewer: Daniel C Brennan, MD (Washington University School of Medicine)Description: This monograph is structured according to infectious agent rather than to bone marrow or specific organ transplant. This provides a comparison and contrast between the two types of transplantation that I found to be extremely helpful and complementary. Purpose: The purpose is to offer a comprehensive review of epidemiology, diagnosis, and management of opportunistic infections in bone marrow or solid organ transplant patients. Audience: This book is written for the medical community at large, not only for transplant physicians and surgeons but for primary care physicians as well. Features: The treatment of viral disease in transplantation is particularly comprehensive and up-to-date. The unique feature is the dedication to transplantation that provides solid recommendations for dose and duration of treatment. This differentiates it from other texts that have treated infections disease in all immunocompromised hosts, including HIV patients, and made it more difficult to obtain specific recommendations for organ transplant recipients who have infections. The specificity of the recommendations make it quite useful for those who are not infectious disease specialists or do not primarily treat transplant recipients. The discussion of the basic bacteriology or virology of each infectious agent is somewhat limited. However, I find this is not a primary shortcoming; in fact, it allows for a more practical focus. If there were any shortcomings, perhaps the discussion of atypical mycobacteria and fungal infections is a bit limited for my own desires given my perception of the increasing incidence of these types of infections in transplant recipients under current immunosuppressive regimens. Assessment: This is a very useful and readable treatment of infectious disease in bone marrow and solid organ transplant recipients. I was able to read it cover-to-cover and I found much practical information and very little duplication. I strongly recommend it for anyone who treats or follows bone marrow or solid organ transplant recipients.

Booknews

Brings together information specific to the management of infectious complications that occur specifically in immunocompromised patients undergoing transplantation. Reviews epidemiology, diagnosis, and management of opportunistic infections, focusing on the needs of clinicians at either a hematopoietic stem cell transplant or solid organ transplant center. Material is structured according to infectious agents rather than type of transplant, with specific differences between solid organ transplant types highlighted within the chapter for each infectious agent. Annotation c. by Book News, Inc., Portland, Or.

RATING

3 Stars from Doody

ACCREDITATION