History of lung transplantation

Abstract

Lung transplantation nowadays is a well-accepted and routine treatment for well selected patients with terminal respiratory disease. However, it took several decades of experimental studies and clinical attempts to reach this success. In this paper, we describe the early experimental activity from the mid-forties until the early sixties. The first clinical attempt in humans was reported by Hardy and Webb in 1963 followed by others with short survival only except for one case by Derom et al. who lived for 10 months. Long-term successes were not reported until after the discovery of cyclosporine as a new immunosuppressive agent. Successful heart-lung transplantation (HLTx) for pulmonary vascular disease was performed by the Stanford group starting in 1981 while the Toronto group described good outcome after single-lung transplantation (SLTx) for pulmonary fibrosis in 1983 and after double-lung transplantation for emphysema in 1986. Further evolution in surgical techniques and in transplant type for the various forms of end-stage lung diseases are reviewed. The evolution in lung transplantation still continues nowadays with the use of pulmonary allografts coming from living-related donors, from donors after circulatory death, or after prior assessment and reconditioning during ex vivo lung perfusion (EVLP) in an attempt to overcome the critical shortage of suitable organs. Early outcome has significantly improved over the last three decades. Better treatment and prevention of chronic lung allograft dysfunction will hopefully result in further improvement of long-term survival after lung transplantation.

Keywords: Lung transplantation; double-lung; heart-lung; history; single-lung.

Figure 1

Pioneers paving the way to human heart & lung transplantation. (A) Alexis Carrel at the time of his Nobel Prize presentation, 1912 (picture courtesy of the Nobel Foundation.); (B) Vladimir Demikhov (picture available at http://bored-bored.com/top-10-mad-scientists-in-history, accessed August 8, 2017); (C) Vittorio Staudacher; (picture courtesy by Dr. Luigi Santambrogio, Milan, Italy); (D) Henri Metras (picture available at http://patrimoinemedical.univmed.fr/rues/rues_metras.htm, accessed August 8, 2017).

Figure 2

The first human lung transplantation was performed on June 11, 1963 at the University Hospital, Jackson, Mississippi by James D Hardy and his team. The donor died of massive heart attack resulting in heart failure and shock and was therefore the first non-heart-beating donor (NHBD), now named donor after circulatory death (DCD). A left SLTx was successfully performed. The recipient, the 58-year-old John Russell with an obstructive tumor in the left main bronchus died 18 days later from renal failure. (A) James D. Hardy (picture available at https://www.umc.edu/som/Departments%20and%20Offices/SOM%20Departments/Surgery/Residents/About-Us/James%20Hardy/James-Hardy.html, accessed August 8, 2017); (B) Original paper as published in Ann Surg presented at the Annual Meeting of the American Surgical Association, Hot Springs, Virgina, April 1–3, 1964 (18).

Figure 3

Three pioneers of human heart-lung transplantation. (A) Denton Cooley, Houston, Texas, 1968 (picture available at http://www.hopkinsmedicine.org/news/media/releases/pioneering_heart_surgeon_denton_a_cooley_dies_at_96, accessed August 8, 2017); (B) Walton Lillehei, University of Minnesota, Minneapolis, 1969 (picture available at http://www.thefamouspeople.com/profiles/clarence-walton-lillehei-5381.php, accessed August 8, 2017); (C) Christian Barnard, Grote Schuur Hospital, Cape Town, South Africa, 1971 (picture available at https://alchetron.com/Christiaan-Barnard-750845-W, accessed August 8, 2017).

Figure 4

Lung transplantation: first mid term survivor in Belgium. (A) Prof. em Dr. Fritz Derom who performed a single-lung transplantation at the University Hospital in Ghent, Belgium on 14^th November 1968; (B) the patient Aloïs Vereecken became the first mid-term (10 months) survivor at the time (25). Pictures available at http://www.ugentmemorie.be/gebeurtenissen/1968-wereldprimeur-longtransplantatie, accessed August 8, 2017.

Figure 5

A right single-lung transplantation performed by Prof. em Dr. Fritz Derom at the University Hospital in Ghent, Belgium on 14th November 1968 in patient Aloïs Vereecken who suffered from end-stage lung fibrosis (silicosis resulting from professional sand-blasting) (26); (permission for reprint given by Fritz Derom at age of 90 years). Available online: http://www.asvide.com/articles/1908

Figure 6

The first long-term success after human heart-lung transplantation was performed by Bruce Reitz and colleagues at Stanford University, Palo Alto, California, on March 9, 1981 (34). (A) Bruce Reitz; (B) picture taking in the operating room during transplantation. (pictures Stanford School of Medicine available at https://twitter.com/StanfordMed/status/707709259778269184, accessed August 8, 2017).

Figure 7

The first long-term success after isolated lung transplantation in patient Tom Hall was performed by the Toronto Lung Transplant Group, Toronto, Ontario, Canada on November 7, 1983 (36). (A) Picture taken in 1987. Surgeons depicted: standing (from left to right): Thomas R. Todd, Joel D. Cooper, G. Alexander Patterson; sitting: F. Griffith Pearson; (B) The Toronto Lung Transplant Group at the 30^th anniversary celebration of the first long-term success after single-lung transplantation. The group is now headed by Shaf Keshavjee (same surgeons as depicted in A with Shaf Keshavjee standing fare right (pictures available at http://www.imsmagazine.com/pioneering-lung-transplantation-in-toronto/, accessed August 8, 2017).