KIDNEY TRANSPLANTS

- autografts = transplanting back into same animal

- allograft (or homograft) = transplanting from one animal to another of same species or from one person to another

- xenografts = transplanting from one species to a different species - including animal-to-human and human-to-animal.

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In 1902, Emerich Ullmann autografted a kidney from a dog back into its neck of the same dog; xenografted a kidney from a dog into a goat; and allografted a kidney from one dog to another(1). Twelve years later, he reported on having tried xenografting the kidney of a pig onto the elbow of a woman - the graft failed to function(2).

Princeteau, in 1905, xenografted pieces of rabbit`s kidney into a child - 16 days later the child died of pulmonary congestion(3).

A year after Princeteau, Mathieu Jaboulay xenografted the kidney of a pig to a woman, by joining the kidney to the blood vessels of her arm(4) - she lived for one hour; and went on to xenografted the kidney of a goat into a patient`s thigh - it failed to function(5).

In 1909, Ernst Unger allografted a kidney of a fox terrier into a boxer dog(6). He went on to xenograft a kidney of a still-born child into a baboon - no urine was produced and the baboon died(7). He xenografted both kidneys of a macaque monkey into the thigh of a woman(8) - she died 32 hours later(9).

Harold Neuhof, in 1923, xenografted a kidney of a lamb into a human patient - who died nine days later(10).

In 1933, Voronoy homografted a kidney of a dead man into woman`s thigh(11) - she died two days later(12). By 1949, he had performed 6 human homografts - but there was no noticeable kidney function in any of them(13).

In 1945, Hufnagel, Hume and Landsteiner homografted a kidney from an unrelated donor to blood vessels to a woman`s arm(14). Two days later, her own kidneys started functioning and the kidney graft was removed(15). She left hospital - but Joseph Murray, later, stated "This episode has been considered erroneously by some as a `success`"(16).

Richard Lawler had allografted kidneys between dogs - which had survived for only two weeks before rejection set in. On 17 June 1950, he homografted a dead woman`s kidney into Ruth Tucker. A month after the transplant, Ruth was allowed home, but by April 1951, Ruth`s kidneys were producing less and less urine and she returned to hospital(17). Lawler operated again and found shriveled dead tissue(18) - a sign of rejection - but Ruth lived for another five years(19). Lawler declared his transplant a `success`(20), but was later rescinded(21).

Hamburger and his team transplanted the first live donor kidney in 1952(22), Removing the kidney from a road accident, they transplanting it into her son(23). The "new" kidney functioned straight away but was rejected 22 days later(24).

In 1953, Hume, JP Merrill et al, grafted a kidney into the leg of a doctor in the final stages of kidney failure. The kidney functioned but after 176 days the recipient died(25).

Joseph Murray performed numerous kidney transplant experiments on dogs. He also attempted 6 human kidney transplants - all were unsuccessful. In 1954, Murray and Merrill were approached by David Miller, who had a patient with severe kidney failure, and were told that the patient had a twin brother. Murray considered transplanting a kidney from one identical twin to another. The first kidney transplant between identical twins went ahead, the "new" kidney functioned, and the recipient lived for another 8 years(25). Murray later wrote "The first twin transplant was a complete success only because it was perfected in operations on hundreds of dogs"(26) - but in his 6 previous human kidney transplants, he had been unsuccessful(27).

In 1955, Merrill reported on 9 successful human kidney transplants. Murray said: "Several of these human allografts functioned better than experimental canine allografts would have predicted"(28). For the transplant between twins, Murray had planned to remove kidney and graft it behind the appendix of the recipient - but before trying this new procedure, he practiced on a human cadaver(29). In "Renal Transplantation", Hamburger records "Animal experiments, however, gave very inconsistent results and we might never have gone on to attempt the procedure in [hu]man[s] but for the influence of John P Merrill"(30).

refs

1. Ullmann,E. Wien Klin Wschr. vol 15. 1902.

2. Ullmann,E. Berl Klin Wschr. vol 60. 1914.

3. Princeteau.,M. J Med Bordeaux. vol 26. 1905.

4. Stark,T. Knife to the Heart. Macmillan. 1996.

5. Morris,PJ [ed]. Kidney Transplantation: Principles & Practice. 3rd ed. WB Saunders Co. 1988.

6. Unger,E. [translation by Landen,RG]. Kidney Transplantation. 1910.

7. Morris,PJ [ed]. Kidney Transplantation: Principles & Practice. 3rd ed. WB Saunders Co. 1988.

8. Unger,E. Berl Klin Wschr. vol 46. 1909.

9. Unger,E. Berl Klin Wschr. vol 47. 1910.

10. Neuhof,H. The Transplantation of Tissues. D Appleton & Co. 1923.

11. Stark,T. Knife to the Heart. Macmillan. 1996.

12. Morris,PJ [ed]. Kidney Transplantation: Principles & Practice. 3rd ed. WB Saunders Co. 1988.

13. ibid.

14. Murray,JE. Science. vol 256. 1992.

15. Stark,T. Knife to the Heart. Macmillan. 1996.

16. Murray,JE. Science. vol 256. 1992.

17. Stark,T. Knife to the Heart. Macmillan. 1996.

18. Newsweek. 3 July 1983.

19. Stark,T. Knife to the Heart. Macmillan. 1996.

20. Lawler,R et al. JAMA. vol 147. 1951.

21. Murray,JE. Science. vol 256. 1992.

22. Michon,L et al. Presse med. vol 61. 1953.

23. Stark,T. Knife to the Heart. Macmillan. 1996.

24. Michon,L et al. Presse med. vol 61. 1953.

25. Stark,T. Knife to the Heart. Macmillan. 1996.

26. Murray,JE. Science. vol 256. 1992.

27. Stark,T. Knife to the Heart. Macmillan. 1996.

28. Murray,JE. Science. vol 256. 1992.

29. Stark,T. Knife to the Heart. Macmillan. 1996.

30. Hamburger,J et al [eds]. Renal transplantation. Williams & Wilkins. 1972.