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The overwhelming success of liver transplantation has led to a dramatic increase in its application. However, the diversity of the patient populations, the variability in the quality and types of donors, and the fluid nature of the specialty make clinical decision making in this specialty complex. Although there are numerous settings for sharing of experience at transplant and liver meetings worldwide and numerous textbooks that cover this shared experience with respect to liver transplantation, there are numerous areas within transplantation where agreement on management is not settled; even conventional immune suppression strategies are debated. It is in such areas that Liver Transplantation: Challenging Controversies and Topics adds value. There are several chapters in the book that address this need, and provide timely insight into such areas of controversy. These include topical and authoritative sections on the management of transplant patients with hepatitis B and C, hepatocellular carcinoma, and adult-to-adult living donor liver transplantation.

Although the compendium is thoughtfully prepared, 2 chapters are especially noteworthy. In light of the very recent, exciting studies indicating that relatively successful tolerance induction strategies are possible in renal transplantation, the chapter on tolerance in liver transplantation offers a well-written and comprehensive analysis of the laboratory and clinical experience indicating that the immunologic response to transplanted livers is unique, and why there seems to be a subset of patients that develop tolerance to their liver grafts. In addition, the chapter on “the share 15 rule” is especially well-written, and being juxtaposed between chapters discussing adult-to-adult live donation and transplantation for hepatocellular carcinoma, allowed an appreciation of the close relationship between organ allocation, patient status, live donation, and the utility of extended criteria donors. In this regard, the authors did an excellent job of carefully explaining how the transplant community has attempted to address how best to utilize precious donors.

Although issues important in pediatric organ allocation are intertwined, a chapter discussing challenges encountered in pediatric transplantation would have been valuable. Difficult questions surround the timing and indications for liver transplant in metabolic diseases, such as maple syrup urine disease, oxalosis, and OTC deficiency, and more generalized mitochondrial disorders that lead to liver failure in the face of neurologic and developmental issues. Some additional important controversial areas are also not represented. There is certainly controversy on the use of auxiliary liver transplantation in children with liver-based metabolic disease and in any patient with acute liver failure. A full chapter on issues and management of patients with acute liver failure would have been helpful, because it is still unclear what factors are important in determining when transplantation should be offered, when transplantation would be too late to affect the outcome, how preoperative and postoperative care can be critical to outcome, and what is the state of the art in extracorporeal liver support. Although chapters on novel immune suppression, long-term metabolic complications, and nonalcoholic fatty liver disease are comprehensive and informative, and may represent problem areas in transplantation, it is not clear that there is much controversy.

The authors of this collection are, for the most part, active clinicians involved in the complex decision making that occurs daily within transplant programs, and describe their experience and recommendations with an unbiased interpretation of the prevailing literature. The book's 6 × 9-inch size makes it easy to carry, and its well-organized, 196-page, 10-chapter format makes it an ideal book to read during travel or on quick breaks from work. The hard cover also allows the book to be carried and packed away without damaging the pages. Despite its wealth of information, the short chapters make it a “quick read,” ideally suited for busy clinicians at almost all levels, but especially for fellows and young faculty. The index is clear, but not really needed, because each chapter is fairly self-contained. Each of the chapters is also supported by an extensive bibliography that can be used by readers that want to pursue specific aspects of each problem in more depth.

Bottom Line: The book clearly hits the mark and is an excellent review of topics critical to physicians and surgeons caring for patients with liver disease. It is well researched, carefully written, and helps the reader to easily understand the many sides of the controversial issues that affect patients who will need or have undergone liver transplantation.