History of Transplantation
The origin.
An ancient tradition dates back the origin of transplantation
to the 3rd century a.C., when Saint Cosma and Damiano miraculously
substituted the gangrenous leg of a sacristan with the one of
a just dead black Ethiopian.
The scientific history of transplantation begins in 1902, with
French surgeon Alexis Carrel, Nobel Prize for Medicine in 1912,
who carried out the vascular anastomosis technique.
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Beato Angelico
"Il Miracolo del Trapianto"
Firenze, Museo di San Marco |
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Thanks to Carrel's new technique the first kidney transplant took
place, from animals to patients affected by kidney diseases. Notwithstanding
the shortness of time of kidney activity, these first experiences
demonstrated the possibility of substituting a sick organ with a new
one.
On the field.
A further improvement took place in the years 40's when, during world
war II, doctor Peter Medawar performed skin grafts on severely burned
patients during London's bombing, discovering the basis of biological
compatibility.
The main problem the first transplant surgeons had to face was the
immunological rejection. Without effective immunosuppressant drugs,
the rejection severely affected transplant results.
Research development leaded to the first real transplant in Boston,
USA in 1954: surgeon Murray performed a kidney transplant from a living
donor to a consanguineous recipient genetically identical.
The forefront.
The first liver transplant was performed in 1963 in Denver by Doctor
Starzl on a two years old boy.
The first heart transplant was performed in 1967 in South Africa by
Professor Barnard.
Although the great improvements of research and surgical techniques,
the first transplant results were non satisfactory for at least thirty
years.
No more than 30% of the patients lived more than a year after transplant.
The most relevant step in transplantation surgery has been the discovery
in 1972, by Jean Francois Borel, a Sandoz Switzerland researcher,
of a new immunosuppressant drug, the Cyclosporine. Cyclosporine proved
to be able to interfere with the activity of T lymphocytes, responsible
of rejection, without interfering with other important anti infection
agents.
The clinical use of Cyclosporine radically changed the results of
kidney, liver and heart transplants leading to a survival rate of
over 70%.
More Progress.
During the last years many important results have been achieved through
scientific research.
In the years 80's Starzl elaborated the theory of micro chimera (
leucocytes exchange between the donor's organ and the recipient),
leading to the possibility of long term tolerance induction by the
recipient.
In the same years the "split liver" technique was developed,
meaning dividing the donor's liver in two parts, the smallest one
to be transplanted into a child recipient, the larger one into an
adult.
And more.
Through antibody therapies it is possible to "reschedule"
the recipient immunological system during transplantation, allowing
a considerable reduction of the quantity of immunosuppressant drugs
to be taken during the whole life.
Questo consente una notevole diminuzione delle dosi di farmaci immunosoppressori
che il paziente deve poi prendere per tutta la vita.
Questi anticorpi e l'avvento di nuovi farmaci immunosoppressori quali
il micofenolato mofetile e la rapamicina hanno permesso di eliminare
completamente l'impiego dei cortisone dagli schemi di immunosoppressione
dei pazienti trapiantati e di ridurre gli effetti collaterali a lungo
termine, migliorando la qualità di vita dei pazienti.
The use of these antibodies and new immunosuppressant drugs (microfenolato
mofetile and rapamicina) allowed to completely eliminate cortisone
from the immunosuppressant therapy reducing long term side effects
and improving the quality of life.
Since the year 2000 scientists are improving islets transplantation
techniques and cell therapy. |
