Title: The first successful transplants, 1960-70
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The first successful transplants, 1960-70
For patients, a last throw of the dice
The first human transplants were heroic operations undertaken at a time when dialysis was not a long term option. A few outstanding stories kept hopes high, but in general, the outcome of these early experiments were down heartening.Photos: Linda Phillips in 1966, at the Western General Hospital, Edinburgh; and at BBC Radio Scotland for an interview in 2008. She had to be carried to this bench for the photo, and received brief dialysis before her transplant from her mother a few months later. 41 years after her transplant she was back on dialysis but well.
After many failed efforts since the first attempt in 1936, the first success was in Boston in 1954. It was between identical twins, so rejection was not a concern. However behind the scenes a great deal of experiment animal work was going on in Boston and elsewhere into surgical technique and possible ways to prevent rejection, with occasional successes.
The UK’s first successful transplant, also between identical twins, was done in Edinburgh by Michael Woodruff in September 1960. The hospital superintendent reported “I think the recipient has a sporting chance of getting away with it”. He did, and died of cancer 6 years later. A second, brother-sister transplant the following year led to death from sepsis after whole body radiation. A third in 1962, only the second transplant using azathioprine, lasted for 20 years.
Meanwhile from 1958 at the Royal Free Hospital in London, John Hopewell and Roy Calne were experimenting with mercaptopurine, the forerunner of azathioprine, and undertook their first attempted transplant in November 1959. Their first potential donor had died of a subarachnoid haemorrhage – they both recall their horror and disappointment at finding that their donor had the same kidney disease – polycystic kidneys – as the patient waiting for the transplant. A second donor’s kidney lasted only 3 days. However their third case, a live donor kidney recipient in November 1960 lived for 49 days, and was found at post mortem to have miliary tuberculosis.
However overall the results were poor. Kolff (the inventor of the first successful haemodialysis machine, now working in the USA) summarised the Cleveland Clinic’s figures and reported world experience to March 1964. He recorded 336 non-twin transplants, of whom 102 were living – but only 14 had been alive more than one year, and 2 for more than 2 years.
From the UK, Parsons and Clark wrote to every transplant unit in Europe in 1965. They learned of 258 transplants and gained information on 187. Two kidneys came from chimpanzees, 100 from deceased donors and 89 from living donors. 22 (maybe 10%?) lived for more than 10 months. 37% of living donor kidneys failed in the first month; 63% of cadaveric. Only 5 of 48 recipients of failed grafts were kept alive by intermittent haemodialysis, the long-term use of which remained a fairly experimental technique at this time. Early anti-rejection protocols included whole body irradiation, invented as a technique to suppress the immune system in 1956, so new transplant units were built next to radiotherapy units. Mortality from infection after irradiation was extremely high, and this inflenced the design of transplant units. A common UK transplant unit design was a row of single rooms with a glass corridor for relatives to wave to the recipients through the window.
Roy Calne joined the Department of Surgery in Boston under Francis Moore in 1960 and brought the use of azathiopine to Dr Murray’s lab and developed its subsequent use. It was only when the use of azathioprine in combination with prednisolone (steroid) for suppressing the immune system became better understood that the statistics began to improve perceptibly. In Edinburgh by the end of 1974, since 1960 127 patients had renal transplants, of whom 37 (29%) remained alive with functioning grafts at 6 months or more. 28 patients had lived more than 2 years, 13 patients more than 5 years, 6 patients more than 8 years and 2 patients more than 12 years. 34 patients were employed, able to do housework, or in full-time education after transplant. 1 patient fathered a child, and 1 gave birth 3 years post-transplant (her photo is at the top of this post).
But by this time long-term haemodialysis was beginning to look more competitive, albeit arduous and expensive. This was a surprise to some, as in several centres it had been introduced by surgeons mainly as a technique to keep patients alive until a transplant could be attempted.
See next: Transplantation takes off in the mid-1960s
Further info:
Hopewell J, RY Calne, I Bewick, 1964. Three clinical cases of renal transplantation. Br Med J i 411-4
Murray JE. Human organ transplantation: background and consequences. Science 1992 256:1411-6
Kolff WJ, RA Straffon, S Nakamoto, 1965. Clinical experience with renal transplantation. Br J Urol 37:370-9
Murray JE. Human organ transplantation: background and consequences. Science 1992 256:1411-6
Parsons FM, Clark PB. Repon on renal transplantation in Europe, based on replies to questionnaire. EDTA Proc 1965; 2: 157-60.
Woodruff MFA. Experience with transplantation of the kidney in man. Ann R Coll Surg Eng 1966 39:178-83.
Woodruff MFA, Nolan B, Anderton JL, Abouna GM, Morton JB, Jenkins A McL. Long survival after renal transplantation in man. British Journal of Surgery 1976; 63: 85-101.
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