When Dr. Thomas E. Starzl successfully transplanted the first human liver at the University of Colorado, more than 40 years ago, it represented the culmination of years of determined research that would later be heralded as among the most significant in medicine and science. The concept of taking an organ from one person and placing it in another to save a life was unthinkable. But Dr. Starzl and a handful of other pioneering surgeons were doing the impossible, and creating an entirely new field of medicine in the process.
When Dr. Starzl arrived in Pittsburgh in 1981 he took his work to new levels and helped transform the University into a medical and research powerhouse. His scientific insights and clinical procedures led to the establishment of the largest liver transplantation program in the world, and elevated already existing heart and kidney transplant programs to international stature.
The University of Pittsburgh became the only center to transplant every kind of transplantable organ, earning Pittsburgh the moniker “transplant capital of the world.” Unprecedented numbers of patients from all corners of the globe traveled to the city seeking the care and expertise of the university’s surgeons, while hundreds of surgical fellows sought training under the tutelage of Dr. Starzl. To this day, the university’s programs attract clinicians from other transplant centers seeking to learn the techniques the Pittsburgh team continues to refine.
The road to successful transplantation hasn’t been easy. In the 1940s, Sir Peter Medawar and Sir Macfarlane Burnet researched tissue rejection and immune tolerance, paving the way for the first operations that would one day follow. Dr. John Murray transplanted the first identical twin kidney in 1954, and South African surgeon Dr. Christiaan Barnard transplanted the first human heart in 1967. One year later, Dr. E. Donnall Thomas performed the first successful bone marrow transplant in which donor and recipient were not twins. And in the decades that followed, liver, heart, pancreas, small intestine, kidney, and multiple organ transplants became relatively routine and highly successful.
Dr. Starzl pioneered the first liver and multivisceral transplantations – first in dogs – in 1958 while at Northwestern University in Chicago. After joining the University of Colorado, Dr. Starzl performed the first successful series of kidney transplants in non-identical twins in 1962 and 1963, and the world’s first successful human liver transplant in 1967. He went on to participate in other medical firsts at the University of Pittsburgh, among them the first multiple organ transplant (intestine, liver, pancreas, and spleen) in 1983, and the first heart and liver transplant in 1984.
Dr. Starzl broke still newer ground in the 1980s when he spearheaded the use of antirejection drugs. These new immunosuppressants greatly improved survival rates and brought transplantation into mainstream medicine where it benefited large numbers of patients who would otherwise have been facing death. While pushing both surgical and pharmacological boundaries Dr. Starzl was also building the largest liver transplant program in the world and training new surgeons in new procedures that would lead to still more breakthroughs.
In 1985, UPMC’s artificial heart team was the second in the world to implant the Jarvik-7 as a bridge to human organ transplantation and the first to discharge a patient after successfully device implantation and heart transplantation.
The medical center team also performed the first successful transplant of pancreatic islets, the cells that produce insulin. The 15-year-old patient remained free from insulin injection use until her death from cancer five years after undergoing a radical "cluster" transplant that involved replacing her liver and removing her pancreas and other abdominal organs.
In 1992, University of Pittsburgh transplant surgeons John Fung, Andreas Tzakis, and Satoru Todo, all of whom later went on to lead transplant programs at other medical centers, performed the world's first baboon-to-human liver transplant on a 35-year-old man dying from hepatitis B. While the patient died from a brain hemorrhage 71 days after the historic surgery, the field of xenotransplantation, or cross-species transplantation, was advanced considerably. In 1993, surgeons attempted a second xenotransplant operation on a 62-year-old man who lived 26 days with the baboon’s liver.
UPMC’s transplant surgeons continue to push the boundaries of medical science. For the last five years, university researchers at Children's Hospital of Pittsburgh, under the direction of Steven Webber, have been engaged in a unique clinical trial that delivers donor bone marrow into the thymus during heart transplantation. Long-term follow-up will determine if patients in these trials will experience less chronic rejection or be able to minimize or completely eliminate the need for immunosuppressant drugs.
Under the direction of Dr. Starzl, UPMC transplant teams are exploring the role that chimerism – the cellular co-existence of both donor and recipient cells – plays in promoting immune tolerance of transplanted organs. Ultimately, chimerism may help to achieve the ultimate goal of eliminating a patient’s need for lifelong antirejection drugs.
Every day, new procedures are developed at UPMC, and every day survival rates increase, which is, after all, the most important way to make history – saving lives that would otherwise be lost.