History Of Organ And Tissue Transplants

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What is the history of organ and tissue transplants? Information about the development of organ and tissue transplants.

History Of Organ And Tissue Transplants

The replacement of injured, diseased, or worn out organs and tissues has intrigued the human imagination since the dawn of recorded history. Early transplantations were primarily skin grafts, and unless the patient’s own skin was used they were rarely successful. Although early surgeons recognized that some physiological process was responsible for the rejection of transplanted tissues, it was not until the early 1900’s that the rejection reaction was more fully understood. It was not until the early 1950’s that whole organs were successfully transplanted.
organ Transplants
Since the mid-1950’s the field of transplantation has been marked by intensive research efforts to develop techniques for combating the rejection reaction. Although several methods have been devised, none is without drawbacks. Modern transplantation has also been marked by astounding progress in the application of transplantation techniques to clinical medicine— that is, the use of transplants to treat a variety of diseases. However, there are still a number of major difficulties that need to be overcome before transplantations can become routine methods of treatment. Better techniques need to be developed for matching donors and recipients, for safely and effectively combating the rejection reaction, and for storing healthy organs for long periods of time in organ banks.

HISTORY

Probably the first written references to transplantations are those in some of the earliest known Egyptian manuscripts, which date back to about 2000 b. c. They allude to the tile makers’ caste, men who were assigned the task of transplanting skin grafts. Early Christian legends, as well as folk tales of the Middle Ages, describe the successful transplantation of noses and even whole limbs from one individual to another. It is, however, highly unlikely that these stories were based on actual cases. In 1597 the Italian surgeon Gaspare Tagliacozzi described his attempts to use flesh from other persons to restore the normal appearance of patients who had lost their noses. He believed that such attempts were unsuccessful because of the force and power of human individuality.

The 1800’s. The scientific approach to transplantation was initiated by G. Baronio, who, in 1804, described skin grafting experiments in sheep and other animals. The first report in modern medical literature of a successful skin transplant was by the German surgeon C. Bunger in 1823. He reconstructed a portion of a woman’s nose with a skin graft obtained from her thigh. This type of transplant—one in which the patient’s own tissues are used—is known as an autograft. It was not until the careful studies of the French physiologist Paul Bert in 1863 that it became generally recognized that transplants of skin or other tissues obtained from one individual and placed on another—allografts—were regularly rejected by the recipient.

The 1900’s. By 1903 the biologist C. O. Jensen had formalized the concept that allograft rejection is mediated by a process of active immunity. In 1912, the German surgeon G. Schône coined the term transplantationsimmunitàt (“transplantation immunity”) for this response.

Probably because of the technical difficulties associated with surgery involving blood vessels, transplants of whole organs were not attempted until the beginning of the 20th century. Utilizing the blood vessel suture techniques developed in 1897 by the famous Chicago surgeon John Murphy, Claude Beck, in 1903, performed an experimental kidney, or renal, transplant. During that decade, a number of other workers reported their initial experiences with kidney transplantations, beginning with E. Ullman, in Germany, who reported the first technical success of renal autografts and allografts in dogs in 1902. Also in 1902, Ullman was the first to attempt to treat a woman with uremia by grafting a pig kidney to her arm. This attempt failed.

The most outstanding contributors to the foundation of modern transplantation during the early 20th century were the French-American surgeon Alexis Carrel and the American physiologist C. C. Guthrie, whose pioneering studies of vascular surgery and subsequent success with the transplantation of limbs and kidneys in experimental animals (1902-1912) provided the technical basis for modern transplantation surgery. Largely stimulated by the work of Ullman, the French surgeon Mathieu Jaboulay in 1906 and the German surgeon E. Unger in 1910 tried unsuccessfully to transplant kidneys from animals into human recipients. These failures, in turn, stimulated further laboratory work, culminating in the development by Carl Dederer, at the Mayo Foundation for Medical Education and Research in Minnesota, of a reproducibly successful technique for transplanting a dog kidney into the neck of another dog.

Dederer also used this method in the first recorded genetic experiments of kidney transplantation in dogs, using littermates and non-littermates (1918). This work was extended by Dederer’s colleague at the Mayo Foundation, C. S. Williamson, who provided the first histological evidence that the differences in survival times of kidney allografts were a probable consequence of different genetic relationships between the donors and the recipients. This theory, which provided an explanation for the immunological reaction of the recipient against the transplanted organ or tissue, received further support from the work of James B. Murphy in 1912 at Rockefeller Institute (now Rockefeller University) in New York City. Murphy also described the first recorded experiments in immunosuppression in organ transplantation, using benzene as the agent to suppress the recipient’s rejection reaction.

Sir Peter Brian Medawar, while working at Oxford in 1944, performed definitive experiments that showed for the first time that repeated graftings from the same donor resulted in accelerated rejection of the transplants. His studies form the basis for modern transplantation immunology, providing clear-cut evidence that, except in the case of identical twins or within inbred strains of animals, in any two individuals of the same or different species their tissue antigens ( special proteins in the white blood cells) will be different. As a result, the transplant recipient recognizes the donor’s tissue as a foreign protein and triggers an immunological response that, in the absence of any immunosuppressive therapy, will eventually result in the destruction of the transplant. TTie degree of antigenic (or genetic) disparity between the donor and recipient plays an important role in determining the speed and intensity of the resulting rejection reaction.

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