The First Human Renal Transplants

Abstract

T he 2 authors are separated by a generation. One is a Nobel laureate transplant surgeon who was associated with the first successful monozygotic twin kidney transplant, the first successful dizygotic twin kidney transplant, the first successful deceased donor renal transplant and the training of scores of transplant surgeons. The other is in the autumn of a renal transplant career that has spanned 33 years at the institution where Joseph E. Murray, J. Englebert Dunphy and Clarence Hodges led the donor and recipient surgical teams for a successful kidney transplant from one 12-year-old monozygotic twin to another on October 9, 1959. The 2 authors met at the 40th anniversary of that program in Portland, Oregon and have been correspondents since. The first human renal allograft was done by Yu Yu Voronoy in the Ukraine on April 3, 1933. The patient was a 26-year-old woman with type O blood who had attempted suicide by ingesting corrosive sublimate (mercuric chloride). The donor was a 66-year-old man with type B blood whose kidney was removed 6 hours after death. With the patient under local anesthesia, the renal vessels were anastomosed to the femoral vessels and a cutaneous ureterostomy was performed. A small amount of bloodstained urine appeared but the patient died 2 days after the procedure. Although technically successful the procedure was doomed from the time of renal revascularization because of prolonged warm ischemia time and ABO blood group incompatibility. In 1945 Landsteiner, Hufnagel and Hume transplanted a human cadaver kidney to the brachial artery and cephalic vein of a young woman with acute renal failure at the Peter Bent Brigham Hospital in Boston. The woman’s own kidneys recovered a few hours later and the allograft was removed without demonstration of significant function. Five years later the first intra-abdominal human renal transplant was done in Chicago by a team led by Lawler. After removal of the recipient’s left polycystic kidney, a cadaver kidney’s vessels were anastomosed to her renal vessels, and a stented ureteroureterostomy was done. Her serum creatinine decreased from a preoperative value of 2.3 to 1.2 mg/dl 3 months later. An indigo carmine test on postoperative day 52 showed excretion from the side of the allograft and from