1. The History of Transplantation
Prof Chris Rudge

2. A (brief) History of (the story behind)Transplantation
Prof Chris Rudge

3. First Human Heart Transplant Cape Town, 3rd December 1967

4. The Times Sept 3rd 2001

5. The Times Sept 3rd 2001

6. Nelson Mandala recalled………….
The Times Sept 3rd 2001
Nelson Mandala recalled………….

7. Nelson Mandala recalled………….
The Times Sept 3rd 2001
Nelson Mandala recalled………….
Chris Rudge said…………

8. Time-line BC Chinese and Indian mythology
280 AD Saints Cosmos and Damian

9. Saints Cosmos and Damian

10. Saints Cosmos and Damian

11. Time-line 1902 Alexis Carrel, Jaboulay:
Vascular anastamosis
Jaboulay, Unger and others
Animal kidney transplants
Voronoy
Human kidney transplants

12. Time-line 1940s and 50s Gorer, Snell, Dausset, Terasaki, Medawar
The immune system
Kuss, Dubost, Servelle in France, Murray, Merrill and Hume in Boston:
Deceased and live donor kidney transplants
Relevance of ABO compatability
Relevance of Anti-HLA antibodies
Cytotoxic cross match
HLA system defined

13. Anecdotes 1950 Calne: Guy’s 1951 Medawar: Oxford 1952 Kuss : Paris
1969 Batchelor: Guy’s

14. Transplants: Clinical Firsts
Cornea Eduard Zirm
1933 (1951-3) Deceased donor kidneys
1952 (Dec 24th) Living donor kidney
1954 (Dec 23rd) First Successful human transplant (LD Kidney)
Liver
Pancreas
Heart
1963 ( ) Lung

15. World’s first successful transplant
The Herrick twins –
Richard and Ronald
Boston USA
23rd Dec 1954

16. Rene Kuss and Tom Starzl

17. Liver Transplantation: Tom Starzl and Roy Calne

18. Pancreas Transplantation: R Lillehei and David Sutherland

19. Heart Transplantation: Christiaan Barnard and Norman Shumway

20. Immunosuppression 1958 Whole-body irradiation
1960s Anti-lymphocyte serum
Methotrexate,
Cyclophosphamide, 6 –MP
Azathioprine
Corticosteroids

21. My three eras of transplantation
Pre 1983: will it ever work?
: how can we make it better?
: why can’t more people have a transplant?

22. Pre 1983
Will it ever work?

23. 3 Month kidney survival 1963

24. 3 Month kidney survival 1963

25. 3 Month kidney survival 1963

26. 1Year survival 1975

27. 1Year survival 1975

28. UK: Kidney Transplantation
1972 – 1976
Graft survival (N=2260)
Patient Survival (N=2098)
Survival % (95% CI)
1 year (71– 75)
5 year (54 – 58)
10 year 45 (42 – 47)
20 year 26 (24 – 28)
Survival % (95% CI)
1 year (52 – 57)
5 year (39 – 43)
10 year 34 (32 – 36)
20 year 26 (24 – 28)

29. Anecdotes
My first patient

30. UK Kidney Transplantation
1955 St Mary’s
1959 Leeds and Royal Free Hospital
1960 Edinburgh
1962 Hammersmith

31. UK Liver Transplantation: Roy Calne and Roger Williams
Addenbrooke’s King’s College
Cambridge London

32. UK Heart Transplantation: Terence English and Magdi Yacoub
Papworth Harefield

33. Anecdotes
My first heart donor:

34. Anecdotes My first heart donor:
“To wrench the quivering heart from a freshly dead corpse is not a procedure with which I wish to be associated”

35. The BTS: memoir of John Hopewell
“In the intervening years ( ) I was occupied by forming the London Transplant Group, which became an almost nationwide organization for the exchange of donor kidneys, ultimately to become the National Kidney Registry. Toward the end of the 1960’s, Leslie Brent of the British Society of Immunology, and I realised that both bodies were planning to become a British Transplantation Society and we had support from each to form a single society under that name. Its inaugural meting was held at the Royal Free Hospital on 12th April 1972, when Sir Peter Medawar was elected as the first president”.

36. What’s happened since 1983? Good things: Immunosuppression
Cyclosporin, Tacrolimus, MMF, Rapamycin, Monoclonal Abs
Surgery, anaesthesia and intensive care
Histocompatability science
Antibiotics and other agents
Biopsy/biomarkers for diagnosis of rejection

37. What’s happened since 1983? Bad things: The donor shortage
Changing donor demographics
Less DBD donors
Age
Co-morbidity

38. UK Kidney Transplantation then v now
Patient survival
Graft survival
Log-rank p<0.001
Log-rank p<0.001
Survival % (95% CI) N
(10 year)
(68 – 71) 6091
(32 – 36) 1931
Survival % (95% CI) N
(10 year)
(72 – 75) 5074
(42 – 47) 2098

39. Challenges for the future

40. Challenges for the future
New science
All the “-omics”

41. Challenges for the future
New science
All the “-omics”
New forms of transplantation
Face
Limbs
? Ovary/uterus

44. Challenges for the future
New science
New forms of transplantation
Managing expectations
Number of organs available
Organ quality
Outcomes

45. <60 years, BMI<30, no history of smoking or hypertension
‘Ideal’ donors
<60 years, BMI<30, no history of smoking or hypertension
No. of donors

46. Challenges for the future
New science
New forms of transplantation
Managing expectations
Avoid complacency
Obsessional care
Continuity of care

47. UK: Kidney Transplantation
1972 – 1976
Patient Survival N=2098)
Graft survival (N=2260)
rvival
Survival % (95% CI)
1 year (52 – 57)
5 year (39 – 43)
10 year 34 (32 – 36)
20 year 26 (24 – 28)
Survival % (95% CI)
1 year (71– 75)
5 year (54 – 58)
10 year 45 (42 – 47)
20 year 26 (24 – 28)