Thomas Starzl

Thomas Earl Starzl (11 March 1926 - 4 March 2017) was an American surgeon and researcher widely regarded as the founder of clinical liver transplantation and a central figure in the development of modern transplant immunosuppression.[1][2] He performed the first human liver transplant in 1963 and the first liver transplant with prolonged recipient survival in 1967, and over the following decades he advanced the drug regimens, from azathioprine and corticosteroids to ciclosporin and later tacrolimus, that made transplantation of the liver and other organs reliably successful.[1][2][3] He is often called the "father of modern transplantation."[2][3]

Early career and the first liver transplants

Starzl was born in Le Mars, Iowa, and trained in surgery, developing an early research interest in the liver and its blood supply.[2][3] On 1 March 1963, at the University of Colorado and the Denver Veterans Affairs hospital, he performed the first human liver transplant; the patient did not survive the operation, and the subsequent attempts that year also ended in death within days to a few weeks.[1][3] The early failures led Starzl to suspend the clinical liver program for about four years while he returned to laboratory work in dogs to refine surgical technique, organ preservation, and rejection control.[1][3]

In 1967 he resumed clinical liver transplantation, this time achieving prolonged survival in a recipient, the first durable success in liver transplantation.[1][3] Survival in this era nonetheless remained poor, with roughly one-third of patients surviving a year, because the available immunosuppression was inadequate.[3]

Advances in immunosuppression

Starzl's central contribution beyond surgical technique was in the control of rejection.[1][2] He helped establish that combining corticosteroids with azathioprine, and later adding antilymphocyte globulin, improved outcomes.[2][3] After moving to the University of Pittsburgh in 1981, he was a leading figure in introducing ciclosporin into clinical liver transplantation, in combination with steroids, which markedly improved survival and helped convert transplantation from an experimental procedure into accepted therapy.[1][3] In 1989 his group reported on tacrolimus (then called FK-506), a more potent immunosuppressant that became a mainstay of transplant medicine.[1][3]

A 1983 U.S. National Institutes of Health Consensus Development Conference, informed substantially by Starzl's results, concluded that liver transplantation was no longer experimental but a legitimate therapy for end-stage liver disease, a watershed for the field.[1][3]

Scientific contributions

Beyond clinical milestones, Starzl made contributions to transplant biology, including studies of immunological tolerance and the phenomenon of microchimerism, the long-term persistence of donor cells in the recipient, which he proposed as a mechanism contributing to graft acceptance.[1][3] He was also an early figure in multivisceral and intestinal transplantation.[1][3] He authored or co-authored an exceptionally large body of scientific work and a memoir, The Puzzle People: Memoirs of a Transplant Surgeon (1992).[2][3]

Legacy

Starzl trained a generation of transplant surgeons and built the University of Pittsburgh into a major transplant center; the institute there bears his name.[2][3] His combined contributions, establishing liver transplantation surgically, and driving the immunosuppression that made transplantation broadly successful, place him among the defining figures in the history of organ transplantation.[1][2][3] See liver transplantation and intestinal and multivisceral transplantation.

See also

• History of organ transplantation
• Liver transplantation · Intestinal and multivisceral transplantation
• Ciclosporin and the immunosuppression era
• Joseph Murray · Christiaan Barnard

References

• Zarrinpar A, Busuttil RW. Thomas Earl Starzl, MD, PhD (1926-2017): father of transplantation. (biographical review). PMC5549009. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5549009/
• American Society of Transplant Surgeons. Thomas Starzl (Chimera Chronicles biography). https://www.asts.org/about-asts/chimera-chronicles/thomas-starzl
• U.S. Department of Veterans Affairs, VA Research. First successful liver transplant (Starzl, Denver VA, 1963/1967). https://www.research.va.gov/research_in_action/First-successful-liver-transplant.cfm ; VA History, Object 83. https://department.va.gov/history/100-objects/083-liver-transplantation/