The ascension of clinical organ transplantation.

D URING 1958 and 1959 at Northwestern Universitv (Chicago). we developed transplantation of the canine liver alone. I parallel to similar independent investigations in Boston hy Francis Moore.:'" The liver also was transplanted as a component of abdominal multivisceral grafts. 4 At the beginning. these were technical and physiologic exercises. because long-term survival of an organ allograft had never been achieved in any species. The possibility of clinically exploiting transplantation brightened. however. between January 1959 and the date of our first human liver replacement in March 1963. During this 4-year period. Joseph Murray in Boston57 and the French teams of Jean HamburgerH and Rene Kuss" produced the 7 examples shown in Table 1 of survival exceeding 6 months following human kidney transplantation. All of the patients except the last one had received total body irradiation, and in addition, 4 of the 5 French patients were treated with unstipulated doses of adrenal cortical steroids (Table 1) whose weak anti rejection effect had been demonstrated by Billingham. Krohn. and Medawar lO in a rabbit skin graft model. The seventh recipient was treated with the 6-mercaptopurine derivative (6-MP). azathioprine. Bob Schwartz's gift to transplantation. II .12 It had been recognized during 1959 to 1962 that total hody irradiation would permit successful renal transplantation in only a small percent of cases. Consequently. the option of immunosuppression with 6-MP or its derivative, azathioprine was greeted initially with feverish enthusiasm. However. the preclinical studies of the new drugs by