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Kidney and Pancreas Transplantation: A Practical Guide, T. R. Srinivas and Daniel A. Shoskes (editors), Humana Press, 2011, 441 pp. ISBN: 978-1-60761-641-2.

Kidney and pancreas transplantation have been the subjects of scores of books. What sets Kidney and Pancreas Transplantation: A Practical Guide apart is the inclusion of material that is not incorporated routinely in other overviews of organ transplantation (1). In the preface the editors identify medical and surgical transplant fellows and practicing transplant physicians as their target audience. Overall, I believe that that they succeed in their purpose of presenting to readers a comprehensive look at both kidney and pancreas transplantation. Of course, some of the chapters are pertinent to the field of solid-organ transplantation as a whole and can serve as a primer for any medical professional.

Virtually every one of the contributors is from the Cleveland Clinic; however, it is refreshing to note that the editors were not interested in writing a book that detailed the Cleveland Clinic approach to transplantation. With the exception of the chapters dedicated to describing surgical techniques, the chapters read as if they could have been written by any expert in the field. Nearly 40 authors combine to write the 25 chapters that comprise this book. Despite this diversity, the writing does not come across as disjointed. With rare exceptions, there is good flow within and between chapters that is likely the result of skilled editing.

The introductory chapters detail the immunologic aspects of transplantation including the role of the histocompatibility laboratory. Immediately following the chapter on immunosuppressants is a chapter titled “Clinical Pharmacologic Principles and Immunosuppression.” It contains some of the same material covered in the preceding chapter. The authors then delve into an exhaustive discussion of pharmacokinetics and pharmacogenetics that is dense and challenging to read. Long paragraphs containing numerous equations and abbreviations are difficult to follow at times. The content of this chapter would have been better suited for a readership of pharmacists.

Recipient evaluation, patient outcomes, pathology, perioperative management, infectious diseases and transplant ethics are covered thoroughly in separate chapters. The chapters describing surgical techniques and postoperative complications are comprehensive and contain high quality diagrams, photographs and radiographic images. The “Laparoscopic Living Kidney Donation” chapter advocates control of the renal vessels with Hem-o-lok clips (Teleflex, Research Triangle Park, NC, USA). Interestingly, the manufacturer of this product amended the instructions for use in 2006, stating that this type of clip was contraindicated for use in controlling the renal artery during laparoscopic donor nephrectomies because of patient injuries and deaths due to uncontrolled bleeding (2). Later, this position was backed by the US Food and Drug Administration, which issued a safety alert for the device. Conversely, studies have been published that support the safety of Hem-o-lok clips for donor nephrectomies; however, I believe that the authors should have included at least one surgical alternative (3).

I was pleased to see novel material not often incorporated in overview textbooks of transplantation. One of the early chapters provides guidance for the design, conduct and reporting of clinical trials. The next to last chapter of the book gives parameters for determining and measuring clinical endpoints and performance. Because of the complimentary nature of the subject material, I believe that these chapters should have been placed consecutively. “The Business of Transplantation” chapter is a concise primer on an important topic rarely taught during the transplant fellowship. It outlines the required and recommended components of a transplant program, and includes a practical summary of the financial piece. A section on maintaining compliance with the policies and regulations established by the Organ Procurement and Transplant Network is also included.

In summary, Kidney and Pancreas Transplantation: A Practical Guide is a well-written and proficiently edited textbook that provides a comprehensive review of the current states of both kidney and pancreas transplantation. Readers will find it to be a valuable clinical reference as they care for this often challenging population of patients.

Disclosure

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The author of this manuscript has no conflicts of interest to disclose as described by the American Journal of Transplantation.

References

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  3. References