Published Monday December 21, 2020
On Dec. 23, 1954, Dr. Joseph Murray performed the world’s first successful human kidney transplant at Boston’s Peter Bent Brigham Hospital (later Brigham and Women’s Hospital). The recipient was Richard Herrick, whose donor was his healthy identical twin, Ronald.
It was a momentous achievement that would earn Dr. Murray a Nobel prize. “Technically, it was proven that this could be done on humans,” said Francisco G. Cigarroa, MD, director of the University Transplant Center in San Antonio.
It helped that the twins were identical. When surgeons began doing transplants on individuals who weren’t as genetically similar as identical twins, the barrier to success became, front and center, rejection.
Rejection occurs when the recipient’s immune system sees the transplanted organ as foreign and attacks it. The first medicines utilized to counter this effect suppressed a recipient’s entire immune system, leaving the patient vulnerable to infections. Early transplant outcomes were predictably discouraging. Then Dr. Jean-Francois Borel, a microbiologist at Sandoz Laboratories, discovered cyclosporine.
Cyclosporine suppresses certain cells (called T-cells) that can reject the transplanted organ, but it doesn’t limit other parts of the immune system. Approved by the U.S. Food and Drug Administration (FDA) in 1983, it was a game-changer in transplantation.
“Now people could reliably have a successful transplant without rejection,” Dr. Cigarroa said. “The next big phase was the development of tacrolimus, which had less side effects than cyclosporine and prevented rejection more frequently.”
The FDA approved tacrolimus for treatment of rejection in liver transplant patients in 1994, in kidney transplant recipients in 1997 and heart transplant patients in 2006.