Wednesday, May 12, 2010

First successful kidney transplant- 1954

Photo: The identical Herrick twins were the first participants in a successful kidney transplant.

The idea of transplanting organs is not new. It can be found in myths of the ancient Greeks and was referred to by even older civilizations. But until the middle of the twentieth century it remained largely impossible, a piece of myth, or fantasy, or science fiction. Skin and eyes were among the first successful transplants. But the larger, more complex, and imbedded organs posed countless problems. The kidney was the first such organ to be successfully transplanted.
Since humans naturally have two kidneys, but can live with just one, the kidney lent itself well to the process. (Of the major organs, the kidney is still the one most often transplanted.) The first attempts in the early 1950s, as in all transplant cases, were made when the only other alternative for the patient was death. These early patients briefly raised hopes by starting a good recovery, but then succumbed. The future of transplant surgery began to look very bleak.
Meanwhile, Peter Medawar in Great Britain had been researching the topic of rejection, which he had observed in skin grafts as a wartime surgeon. He found that graft recipients would form antibodies against the graft, unless they had been exposed to similar foreign tissue early in life. (He used chickens for his research subjects.) Medawar's work showed that the body's rejection of foreign tissue was indeed an immune response. He and another researcher received the 1960 Nobel Prize for this discovery.
But in 1954....

 at the Peter Bent Brigham Hospital in Boston, a special kidney transpant case would succeed and teach medicine a great deal by co
 nfirming Medawar's results. Richard and Ronald Herrick were identical twins, but Richard was dying of kidney disease. Ronald donated one of his kidneys, and it was successfully transplanted into Richard. Because they were identical twins, the organ did not appear foreign to Richard's body, which did not reject it.

How could they trick the body into not rejecting the new, healthy kidney that it needed? X-rays were tried, bombarding the patient's entire body. The immune system was indeed knocked out, but in many cases the radiation killed the patient. In 1959, two more doctors in Boston discovered that certain drugs could suppress the immune system as effectively as radiation, but without the side effects of x-rays. One of these drugs was Imuran, originally formulated to fight leukemia. In addition, in 1960, Peter Medawar introduced a way of typing tissue, just as blood typing had been discovered in 1900. By 1962, tissue typing and immune suppression with drugs was used for the first time in a human kidney transplant. Between 1954 and 1973, about 10,000 kideny transplants were performed.
A more effective immunosuppressant, cyclosporine, has been discovered. Cyclosporine, generally introduced in the 1980s, was a breakthrough in preventing rejection and opened a new era in transplant surgery. In 1986 alone, for example, nearly 9,000 kidney transplants were performed in the United States, with a greater than 85 percent survival rate for the first year

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