Tuesday, November 5, 2013
A half century of transplant innovation
Fifty years ago, Joyce Wallin discovered that one of her kidneys hadn’t been working for years, and that the other was diseased and getting worse.
Wallin received a kidney transplant from her identical twin, Jeanet, on June 7, 1963. It sounds routine by today’s standards, but that surgery, by Richard L. Varco, was the first-ever solid organ transplant performed by University of Minnesota physicians.
And that first was hardly the last. In the ensuing half century, the University of Minnesota has taken its place as a global leader in the world of transplant medicine. The U’s transplant program has completed more than 13,000 transplants.
Among the numerous “firsts” associated with the University:
- the world’s first pancreas-kidney transplant, by Richard C. Lillehei and William Kelly in 1966;
- the world’s first intestinal transplant, by Lillehei that same year;
- the world’s first heart transplant, by U-trained Christiaan Barnard in 1967; and
- the first allo-islet cell transplant from a deceased donor to a living recipient to treat type 1 diabetes, by David Sutherland and John Najarian in 1974.
The names of the pioneers—Lillehei, Varco, Najarian, Richard L. Simmons—are among the who’s who of medical giants, and their work carries on in ever-growing numbers. Earlier this year the U’s transplant team performed its 8,000th kidney transplant, just shy of 50 years from the date of the first.
“We are clearly recognized as being one of the dominant [transplant] centers,” says Timothy Pruett, John S. Najarian Clinical Chair and head of the U’s Division of Transplantation. “On the service side, we’ve been right at the forward cusp of lots of different things.”
In addition to performing thousands of transplants, the U is known for educating the world’s best.
“One of the major contributions that Minnesota has made has been the training program of transplant professionals,” Pruett says. “In the mission of the University as an educational body, it has supplied to the country and the world an inordinate number of people who are leading transplant clinicians.
“It was the first training program in the country. Dr. Najarian started that. He was the first chair of the society that started accrediting programs to train people and set the standards for what they were.”
Not the kind of crowd we want
Although he’s happy to brag about U’s successes, Pruett points out that we have a long way to go to address a growing need for organs.
To illustrate, he uses TCF Bank Stadium for scope. The stadium holds 50,805 people, and if you’ve been there you can probably picture a mass of fans wearing maroon and gold.
Now try to picture them needing organ transplants. The waiting list today in the United States is 119,948—or about 2.4 stadiums worth of people, Pruett says. Some 98,000 people are waiting for kidneys alone—enough to fill two stadiums.
The gap is widening. In 2012, there were 56,000 new people on the wait list—more than one full stadium—and over 36,000 were added just for kidneys, he says. But in 2012, just 22,000 people received an organ transplant from a deceased donor.
Saving organs … and lives
At the same time, advances in transplant science—as well as skill and judgment—are enabling surgeons to make the most of a limited donor pool.
Gabe Loor came to the University in July from the Cleveland Clinic, and he’s happy to tell the story of how he and his team procured a lung for 57-year-old “Therese.” Therese had a condition called Idiopathic Pulmonary Fibrosis that was aggressive and progressing rapidly. Her prognosis was not good.
Loor and colleagues were called with an offer of a lung from a deceased patient in Wisconsin, but there were problems.
The patient there had suffered trauma, but there was also some unexplained air and fluid on the right side of lung, suggesting further, potentially serious, concerns. In fact, the lung had already been turned down by two major centers.
“While we were concerned for these findings, we thought that we were close enough, and we had the personnel and the commitment to Therese that we felt it was important for us to go and examine the lung.”
When they did so, it became apparent that a chest tube had caused an abrasion of one of the arteries in the rib space and an abrasion of the diaphragm, “but had in no way at all affected the lung,” Loor says. “The lung looked better than an 18-year-old’s lung. … We went back in and had an uneventful implant, and the patient did fantastic.”
And Loor beams with excitement at a new opportunity. The U is one of a handful of centers that will be partaking in a new trial in which it will utilize a machine that can keep a donor lung actually “breathing.”
In fact, surgeons from the U recently performed the first "breathing lung" transplant in the Midwest—on a 51-year-old Minnesota male—and hope that the machine will extend the time they have to perform a transplant and improve survival rates. (View a video highlighting the new device.)
It truly is breathtaking science, and Loor says the invite to the trial is emblematic of the U’s status among transplant programs.
“The reason we were invited to be a part of this trial is because of our excellent and reliable transplant infrastructure and our rich tradition in transplantation at the University.”
It’s opportunities like this that have Pruett also happy to call the University of Minnesota his working home.
“The fun of being in a university is making the world a little bit better today that it was yesterday,” he says, “and the goal is to make it better tomorrow than it is today.”
Contact the writer at firstname.lastname@example.org.