Title: The AST Handbook of Transplant Infections, by Deepali Kumar and Atul Humar
Abstract: “Only a fool learns from his own mistakes. The wise man learns from the mistakes of others.” Otto von Bismarck The field of transplantation infectious disease was a necessary extension of the growth in the population of immunosuppressed individuals, notably those receiving solid organ or hematopoietic stem cell transplants. This growth has been further fueled by the availability of newer antimicrobial agents (largely for viruses and fungi), susceptibility testing and the newer nucleic acid and protein-based diagnostic assays that have allowed increasingly specific diagnoses of infectious processes. Most “card carrying” ID specialists have studied the large textbook “bibles” of infectious disease but, in reality, depend on the availability of small handbooks (e.g. the “Sanford Guide”) filled with essential information on the selection and dosing of antibiotics. Despite the growth of the field, there has never been a guidebook for the care of infections in transplantation. Into this gap, Kumar and Humar and the American Society of Transplantation (AST) Infectious Diseases Community of Practice have introduced The AST Handbook of Transplant Infections. The subject-matter is divided into 57 short chapters each with a sharp focus on one aspect of transplantation, both hematopoietic and solid organ. General reviews of the “approach to the patient” cover organ-specific infectious syndromes pre- and posttransplantation. Specific pathogens, donor issues, vaccination tables, prophylactic strategies and life-style issues and drug management and interactions follow in subsequent sections. The sections are brief, often presented as tables or flow diagrams, and are well edited for consistency of style. The focus is on practical, bedside information, and is well indexed to allow the uninitiated to find information quickly. The Handbook provides a useful starting point for the clinical care of the most common infections of immunocompromised hosts. The topics covered represent areas that may be unfamiliar to many medical or surgical practitioners and should be of particular use to trainees, nurses and to clinicians who see transplant recipients uncommonly. The difficulty of this or any such “guide” is the lack of prospective trial data to support some common uses of antimicrobial agents or diagnostic assays. These gaps represent much of the “art” of infectious disease and would be expected to be beyond the scope of this volume. These variables are addressed by “comments” within tables, but might have also provoked an asterisk—“*Please call the Transplant and Compromised Host Infectious Disease Service for these indications”. Particularly useful are the drug side-effect and interactions tables. Minor points might be that the subject-matter of some chapters may not be clearly indicated to the nonexpert by the chapter title (e.g. “Estimates of Window Period Length” or “Residual Risk”) and that some materials might be better presented as tables rather than as lists. It is uncertain whether there need to be three chapters on the effects of various antibody therapies. A question that must have arisen in preparation was whether there was a need for references in each chapter. The selection of two to three key references for each topic might have been a valuable addition. Overall, however, this is to be applauded as a remarkable first effort. This is a very useful addition to the transplant literature; the authors have promised that the Handbook will be updated regularly. As for all good things, this manual will, hopefully, find its next life as an “App” on our cellphones.