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. 1965 Feb:58:131-47.
doi: 10.1097/00007611-196502000-00001.

CLINICAL EXPERIENCE WITH ORGAN TRANSPLANTATION

T E STARZL, T L MARCHIORO, D RIFKIND, D T ROWLANDS Jr, W R WADDELL

CLINICAL EXPERIENCE WITH ORGAN TRANSPLANTATION

T E STARZL et al. South Med J. 1965 Feb.
No abstract available

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Figures

FIG. 1
FIG. 1
Method of combined perfusion and cooling of kidneys employed in two humans cases. Immediately after death, the cannulas are placed in the femoral vessels. The priming solution is heparinized in advance, and 1 Gm. per liter of procaine chloride is added to the perfusate. Selective perfusion of the lower portion of the cadaver is obtained by cross-clamping the lower thoracic aorta. (Marchioro et al., by permission of Surgery, 54:900, 1963.)
FIG. 2
FIG. 2
Method of infusion used to cool and wash the kidney in those cases where the donor and recipient patients have different major blood types. Good flow cannot be obtained without the addition of procaine chloride. Note that heparin is added to the lactated Ringer’s solution which is cooled to 15° centigrade. (Starzl et al., by permission of Surgery, 55:193, 1964.)
FIG. 3
FIG. 3
General technic of renal transplantation. Note the tunnel and nipple technic used for ureteroneocystostomy. (Starzl et al., by permission of JAMA, 187:734, 1964.)
FIG. 4
FIG. 4
Depiction of details of immunosuppressive therapy. Note deterioration of renal function after 19 days, and subsequent reversal of this process. Acti-C, actinomycin C. LN, left nephrectomy at time of transplantation. RN, right nephrectomy, lmuran is synonymous with arathioprine. The patient still has normal function, now seven months postoperative. (Starzl et al., by permission of Surg Gynec Obstet 117:383, 1963.)
FIG. 5
FIG. 5
Rejection crisis in case treated initially with irradiation. Note transient oliguria, depression of creatinine clearance, and elevation in BUN., blood pressure, and excretion of urinary protein. The changes were all reversible. The patient previously had bilateral nephrectomy, splenectomy, and thymectomy. R-dose total body irradiation. Acti.C—each arrow equals 200 mcg. actinomycin C intravenously. Imuran is synonymous with arathioprine. The patient now has normal renal function one year postoperatively. (Starzl et al., by permission of Surg Gynec Obstet 117:383, 1963.)
FIG. 6
FIG. 6
Kidney provided by an A positive donor to an O positive recipient, and removed 3 hours after revascularization. None dark color of organ.
FIG. 7
FIG. 7
Angiogram obtained after removal of a homograft, obtained from a B positive donor and transplanted to an O positive recipient. The kidney was removed three hours after it had been placed because of its cyanotic appearance. Note major vessels are open but that outer cortex is a vascular.
FIG. 8
FIG. 8
Rejection crisis observed in second case treated at the University of Colorado Medical Center. The episode was unusually severe, with development of anuria on the 26th to 29th days after operation. The process was completely reversible, and the patient now has normal renal function, 10 months after operation. (Starzl et al., by permission of Surg Gynec Obstet 117:383, 1963.)
FIG. 9
FIG. 9
Development of early rejection crisis after 36 hours, following an initial brisk diuresis. Although temporary anuria resulted, the crisis was reversed. Such an early rejection episode is encountered in approximately 15% of these cases. (Starzl et al., by permission of Surg Gynec Obstet 118:819, 1964.)
FIG. 10
FIG. 10
View of the completed subhepatic vascular and common bile duct anastomoses. An additional anastomosis of vena cava is located at the diaphragm. Note that the arterial anastomosis is performed distal to the recipient gastroduodenal artery and proximal to the donor gastroduodenal artery. The T-tube is placed through the recipient portion of the composite common duct. (Starzl et al., by permission of Surg Gynec Obstet, 117:659, 1963.)
FIG. 11
FIG. 11
(Case 4, Table 7). The patient had cirrhosis with a super-Imposed primary hepatoma. Note numerous satellite tumor nodules replacing virtually all of normal parenchyma.
FIG. 12
FIG. 12
(Case 4. Table 7). posterior view of viscera excised en bloc at autopsy. Note the large fresh thrombus occupying most of the lumen of the inferior vena cava in the upper portion of the photographic view.
FIG. 13
FIG. 13
(Case 4. Table 7). Histologic section of liver homograft. Note relatively well-preserved parenchymal architecture, as well as the focus of round cells in the periportal area in the right lower portion of the field. There was a fine mononuclear cell infiltrate scattered throughout the lobules as well (H & E. X 32).
FIG. 14
FIG. 14
(Case 5). Primary hepatoma. All dark cells in the field are neoplastic, no normal parenchyma is seen (H & E. X 80).
FIG. 15
FIG. 15
(Case 5). Note the striking early rises in SGOT, and bilirubin with later partial reversal of these abnormalities. On the 16th postoperative day, the patient’s condition deteriorated, and a secondary rise in bilirubin occurred. Immunosuppressive therapy is depicted at bottom of chart.
FIG. 16
FIG. 16
(Case 5, Table 7). The hepatic homograft shows rather poor staining quality of large portions of the field, as well as a few scattered lymphocytes throughout. Heavily stained amorphous areas are collections of bile, suggestive of biliary stasis (H & E. X 32).
FIG. 17
FIG. 17
(Case 5). Higher power view of liver showing a portion of a portal area containing many small lymphocytes (H & E. X 160).
FIG. 18
FIG. 18
(Case 5). Reticulum of liver shows good preservation of stroma. (Silver stain. X 80).
FIG. 19
FIG. 19
Experimental procedure in patients with disseminated malignancies who were treated with splenic homotransplantation. Note that the donor is sensitized with the recipient’s tumor in each case. (See text for details.)
FIG. 20
FIG. 20
Details of removal of spleen from the donor. The gastrosplenic ligament is divided separately, allowing skeletonization of the central splenic vessels.
FIG. 21
FIG. 21
Method of Infusion of the splenic homograft with cold solution after its removal from the donor patient.
FIG. 22
FIG. 22
Technic of transplantation of the spleen. The spleen is placed in the right iliac fossa and the anteroposterior relationships of splenic surface and the pedicle are reversed, the former raw area of the splenic capsule now being directed anteriorly. The hypogastric artery and external iliac vein are used for the anastomoses.
FIG. 23
FIG. 23
(Case 5). Preoperative chest x-ray of a 12 year old child with hypogammaglobulinemia show atelectasis of both lower lobes. Since operation, the radiographic appearance of the chest has not changed materially.
FIG. 24
FIG. 24
(Case 5). Scintogram shows concentration of radioactivity in the patient’s own spleen (upper right) and in the splenic homograft (lower left). The examination was done 30 days after the homotransplantation operation.
FIG. 25
FIG. 25
Scintogram of abdomen three months after splenic homotransplantation. Note concentration of radioactivity in the child’s own spleen (upper right), with greatly diminished activity in the transplant (lower left).
FIG. 26
FIG. 26
Schematic depiction of a possible balance between the graft and the host in the patients with splenic homotransplantation. (See text for details.)
FIG. 27
FIG. 27
(Case 1), Preoperative chest x-ray of splenic homotransplantation. The patient had a histologically proven diagnosis of alveolar cell carcinoma of the lung by biopsy from the left lower lobe. Note also small lesions on the right side.
FIG. 28
FIG. 28
Same case as figure 27. Patient had received splenic homotransplantation eight months previously. Note that the pulmonary lesions have progressed in size and number.
FIG. 29
FIG. 29
(Case 4). Splenic homograft at autopsy 10 days after operation. There is virtual disappearance of the white pulp; there is an area of necrosis in the upper left portion of the field (H & E. X 32).
FIG. 30
FIG. 30
(Case 2). Splenic homograft at autopsy. There are small numbers of lymphocytes and other mononuclear cells. A relatively amorphous and fibrotic pattern characterised the microscopic picture (H & E. X 32).
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