A half-century retrospective of transplantation as viewed by the protagonists my own reminiscences.pdfVIP

A Half-Century Retrospective of Transplantation as Viewed by the Protagonists: My Own Reminiscences R. Calne JUST as the Wright brothers’ plane launched the science of aviation and led to an undreamed of change in travel, so the early experiments in organ transplantation have changed our way of looking at medicine, restoring many patients facing death to an excellent quality of life for many years. This has depended on the work of individuals all over the world, and their many contributions have helped us to deal with the two major problems involved in organ transplantation: namely the surgery of the operation and keeping the donor organ alive, and preventing the recipient’s immune system from rejecting the organ. The successful transplantation of kidneys between identical twins by Dr. Murray and his team clari?ed the required surgical technique.1 The immunology of rejection was de?ned by Medawar and his colleagues.2,3 Gradually it became possible to overcome organ rejection in the laboratory and then in the clinic, using immunosuppression, initially with drugs used to treat cancer. More speci?c agents were found during routine screening in laboratories of substances produced by fungi and bacteria, but did not come into their own until many years later. Looking back on my work in transplantation, for me the most signi?cant changes were related to papers in the Lancet. In 19604 when still a trainee in surgery at the Royal Free Hospital in London, I reported on a kidney transplant in a dog which lasted 47 days with treatment with 6-mercaptopurine, a drug used for leukemia. This was an obvious improvement on the 7 to 10 days’ survival without treatment. On a Harkness scholarship, I spent 18 months in Boston working with Drs Moore and Murray developing this approach and found that a close relative of mercaptopurine, azathioprine, was slightly superior to 6-mercaptopurine. Azathioprine is still used today for patients with organ transplants. In 1978 we reported in The La