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Kidney Transplantation: Past, Present, and Future

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Transplantation is a recent phenomena.  Many of the big developments in this discipline have taken place within the past 40 years.  This part of the web site will highlight some of the key events, people, and cases that have contributed to kidney transplantation as we know it today.  Much of the story of transplantation is a story of barriers and how modern scienctific medicine overcame those barriers.  This time line gives a brief outline of how transplantation progressed through this century.  Following it is a list of the barriers to transplantation that science has studied and dealt with to make transplantation possible.  Click on those barriers to find out more about how transplantation went from fantasy to reality within this century.

EARLY EXPERIMENTS

1902 - The first sucessful experimental kidney transplants were performed at the Vienna Medical School in Austria with animals.

1909 - The first kidney transplant experiments were performed in humans in France using animal kidneys.

  • A surgeon inserted slices of rabit kidney into a child suffering from kidney failure.  Although “the immediate results were excellent” the child died about 2 weeks later.
  • While such transplants did sucessfully produce urine, they lasted only for about an hour before ceasing to function.
  • Scientists of the time believed kidney transplants were possible, but their success was limited by unknown “biochemical barriers,” which prevented long-term kidney survival.

1933 - The first human-to-human kidney transplant was performed

  • Unknown to doctors at the time, there were mismatches in donor and recipient blood groups and the donor kidney never functioned

1940’s - Sir Peter Medawar at the University of London experimented with the immunologic basis of organ rejection.

Early 1950’s - Cortisone-like medications were used to suppress the human body’s self-defense system (immune system), resulting in some kidney transplant success.

THE PERFECT MATCH

1954 - Joeseph E. Murray and his colleagues at Peter Bent Brigham Hospital in Boston performed the first truly successful kidney transplant from one twin to another.  This was done without any immunosuppressive medication.  A photograph of this procedure is seen above.

  • Scientists predicted that immune system reactions should be minimal between identical twins (because their organs were indistinguishable to each other’s immune systems).
  • More kidney transplants between identical twins were successfully performed, and some of those kidney recipients are still alive today.

REJECTION PERFECTION

Late 1950’s - New approaches were needed to prevent the body from fighting off a “foreign” donor kidney when an identical twin donor was not available. 

1960’s - TISSUE TYPING ADVANCEMENTS - Better techniques for matching donor and recipient blood and tissue types, as well as improvements in preserving cadaveric (from recently deceased donors) kidneys, were developed.

1961 - IMMUNOSUPPRESSION ADVANCEMENTS - Powerful immunosuppressives became available and, in combination, helped decrease the chance for kidney rejection

1980s and 1990s - New tecniques, new medications and new patient information have helped make kidney transplants a safer, more effective and more routine procedure

BARRIERS

In order for sucessful kidney transplants to become a reality, science needed to outwit the human body’s own defense systems.

THE PROCEDURE

First, surgeons had to develop a surgical procedure that would not only place a new kidney in the patient, but connect all the necessary tubes and blood vessels.  This was largely done by surgeons like Dr.Thomas Starzl.  Click on his name to read more about these early developments.

DIALYSIS

Throughout all of this experimentation, there were other developments being perfected that helped keep renal failure patients alive.  These was called kidney dialysis and it kept patients alive by using an artificial kidney to purify human blood, which is what normal functioning kidneys do every day.   In 1948 Dr. Willem Kolff first used his  Kolff-Brigham “artificial kidney” on human patients and set the stage for innovative new approaches to controling renal disease.   Click on his name to learn more.

REJECTION

Scientists needed to learn why organs our bodies rejected new organs.  The pioneering work in this field of immunology  was largely done during the 1950s by researchers like Dr. Joseph Murray.

IMMUNOSUPPRESSION

After scientists more accurately understood why our bodies fight off foreign organs, they experimented with ways to combat these defences.  Surgeons used X-ray, bone marrow infusion, immunoparalysis, donor-recipient matching, and drugs to stop rejection.  Dr. Joseph Murray describes the evolution of these techniques in this article.

ORGAN PRESERVATION

 Another crucial part of kidney transplantation is proper organ preservation.  Although today’s solutions and cooling methods can be safely preserve kidneys for up to 48 hours, there were times when surgeons rush organs from decapitated prisoners!  Click here to learn more about these early organ procurement techiques as remembered by Dr. Folkert O. Belzer.

 

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