Lung Transplantation
http://www.100md.com
《新英格兰医药杂志》
Lung transplantation has assumed an important role in the therapeutic approach to selected patients with advanced lung disease, but the procedure remains plagued by numerous problems that limit its widespread applicability and constrain its outcomes. Increasingly, the supply of suitable donor organs is insufficient to meet current demands. Immunosuppressive therapy is associated with myriad risks, most notably infection, renal failure, and malignant disorders. Despite current immunosuppressive strategies, rejection of allografts is common and frequently leads to irreversible organ dysfunction. As a consequence of these problems, lung transplantation remains limited in its ability to appreciably extend life; median survival is only five years. Judicious selection of candidates and vigilant care of recipients are essential to an optimal outcome, but the achievement of enduring results awaits further scientific and clinical advances. It is with this perspective that Lung Transplantation comprehensively reviews current clinical issues and casts an eye toward the future of the field.
The first section consists of 10 chapters detailing the diseases for which transplantation is most commonly indicated. Four of these chapters are devoted to various aspects of pulmonary hypertension, a curious editorial choice, given that pulmonary vascular disease is the indication for less than 5 percent of transplantation procedures worldwide. In addition, the section has inconsistencies in the breadth of material covered. For example, the chapters on pulmonary hypertension focus exclusively on aspects of the disease itself, avoiding any discussion of issues related to transplantation, such as the controversy regarding the optimal surgical procedure. In contrast, the chapter on cystic fibrosis superficially reviews the molecular basis of the disease and recent advances in treatment, offering a discussion of lung transplantation that is at times specific to cystic fibrosis and at other times overly generic in scope. The chapters on emphysema and bronchiectasis are much better balanced in their coverage.
The strength of this textbook lies in the second section, which contains well-written, comprehensive chapters on lung transplantation. Topics covered in this section relate broadly to patient selection, surgical techniques, and post-transplantation care. Chapters on mechanisms of graft injury and immunosuppressive agents provide a strong foundation of the immunologic principles that underlie clinical care. A chapter devoted to imaging and a chapter on transplant pathology offer, respectively, extensive radiographic and histopathological images of post-transplantation complications. Another highlight of this section is a discussion of the psychological aspects of chronic lung disease and lung transplantation, issues that have received far less attention than the physical health of patients but that are equally important to the quality of life.
The final section of Lung Transplantation looks to the future, with chapters on tissue engineering, xenotransplantation, and the artificial lung. Notably absent is a discussion of expanding the donor pool through the use of organs from donors without a heartbeat. A detailed discussion of current research efforts to induce immunologic tolerance also would have fit nicely with the theme of the final section, since tolerance may be the holy grail that will permit achievement of long-term graft and patient survival.
Despite these relatively minor criticisms, Lung Transplantation succeeds as a state-of-the-art review of an evolving field. The book is relevant not only to transplantation specialists but to all clinicians who care for patients with advanced lung disease. Comprehensive in scope, this textbook is nonetheless sufficiently succinct to permit it to be read cover to cover and sufficiently well written to motivate one to do so.
Robert Kotloff, M.D.
University of Pennsylvania Medical Center
Philadelphia, PA 19104
kotloff@mail.med.upenn.edu(Edited by Nicholas R. Ban)
The first section consists of 10 chapters detailing the diseases for which transplantation is most commonly indicated. Four of these chapters are devoted to various aspects of pulmonary hypertension, a curious editorial choice, given that pulmonary vascular disease is the indication for less than 5 percent of transplantation procedures worldwide. In addition, the section has inconsistencies in the breadth of material covered. For example, the chapters on pulmonary hypertension focus exclusively on aspects of the disease itself, avoiding any discussion of issues related to transplantation, such as the controversy regarding the optimal surgical procedure. In contrast, the chapter on cystic fibrosis superficially reviews the molecular basis of the disease and recent advances in treatment, offering a discussion of lung transplantation that is at times specific to cystic fibrosis and at other times overly generic in scope. The chapters on emphysema and bronchiectasis are much better balanced in their coverage.
The strength of this textbook lies in the second section, which contains well-written, comprehensive chapters on lung transplantation. Topics covered in this section relate broadly to patient selection, surgical techniques, and post-transplantation care. Chapters on mechanisms of graft injury and immunosuppressive agents provide a strong foundation of the immunologic principles that underlie clinical care. A chapter devoted to imaging and a chapter on transplant pathology offer, respectively, extensive radiographic and histopathological images of post-transplantation complications. Another highlight of this section is a discussion of the psychological aspects of chronic lung disease and lung transplantation, issues that have received far less attention than the physical health of patients but that are equally important to the quality of life.
The final section of Lung Transplantation looks to the future, with chapters on tissue engineering, xenotransplantation, and the artificial lung. Notably absent is a discussion of expanding the donor pool through the use of organs from donors without a heartbeat. A detailed discussion of current research efforts to induce immunologic tolerance also would have fit nicely with the theme of the final section, since tolerance may be the holy grail that will permit achievement of long-term graft and patient survival.
Despite these relatively minor criticisms, Lung Transplantation succeeds as a state-of-the-art review of an evolving field. The book is relevant not only to transplantation specialists but to all clinicians who care for patients with advanced lung disease. Comprehensive in scope, this textbook is nonetheless sufficiently succinct to permit it to be read cover to cover and sufficiently well written to motivate one to do so.
Robert Kotloff, M.D.
University of Pennsylvania Medical Center
Philadelphia, PA 19104
kotloff@mail.med.upenn.edu(Edited by Nicholas R. Ban)