Starzl and the first liver transplants

In the late 1950s Thomas Starzl, then at Northwestern University in Chicago, worked out ways to replace the liver in dogs, and in 1958 the animals began to survive the operation. He and Francis Moore at the Peter Bent Brigham Hospital in Boston solved many of the same problems independently. Starzl cooled donor livers by flushing them with chilled solutions, now a universal practice. At the University of Colorado in Denver he ran a kidney transplant program, giving azathioprine before surgery and adding prednisone, and he planned to use the same two drugs for the liver.

On 1 March 1963 he attempted the first human liver replacement, in a 3-year-old child with biliary atresia. The child bled to death during the operation. Four more Denver patients died over the next seven months, the longest after 23 days, and attempts in Boston in September 1963 and Paris in January 1964 also failed. Clinical trials stopped. The livers recovered at autopsy showed no signs of rejection; bacterial infections, partly caused by bypass tubing that had been essential in dogs, had killed most of the patients.

Starzl improved the operation in many ways and added antilymphocyte globulin to his drug regimen. Two more attempts, in October 1966 and May 1967, also failed. On 23 July 1967 a girl aged one and a half, treated for a liver cancer, received a new liver and lived more than 13 months before dying of metastases. On 2 May 1968 Roy Calne at Cambridge and R. Williams of King's College in London treated the first patient of a second program.

Survival stayed poor for a decade. In Starzl's three consecutive series before cyclosporin, one-year survival was 28.8, 50 and 34.5 percent. Calne brought cyclosporin A into clinical use in the late 1970s, and Starzl showed that its kidney toxicity could be reduced by combining it with prednisone. In 1983 a US consensus conference concluded that liver transplantation had moved past experimental status into a clinical service. In 2009 almost 50,000 Americans were living with a transplanted liver. Calne and Starzl shared the 2012 Lasker clinical award.