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. 1970 Jun;10(6):291-7.
doi: 10.1016/0022-4804(70)90047-8.

A look ahead at transplantation

T E Starzl

A look ahead at transplantation

T E Starzl. J Surg Res. 1970 Jun.
No abstract available

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Figures

Fig. 1
Fig. 1
Preservation unit. The perfusion pumps are located outside the hyperbaric chamber; the organ receptacle, the oxygenator, and the venous reservoir are inside. The various chamber inlets permit sampling of the perfusate, gas sterilization, and oxygen delivery and removal. The temperature is electronically controlled. (By permission of Surg. Gynec. Obstet. 126:263, 1968).
Fig. 2
Fig. 2
A rejecting orthotopic liver homograft in a patient who was said to have an A histocompatibility match with the donor. The protruding homograft as it was seen when the transverse abdominal incision was reopened. Note the enormous swelling, as well as the heterogeneous appearance of its surface. This liver was removed at the same operation and replaced with a second homograft which came from a donor with a D match. Although the second organ also underwent a severe rejection, it supported life for an additional year.
Fig. 3
Fig. 3
A 4-year-old child with intrahepatic biliary atresia who was treated with orthotopic liver transplantation. The histocompatibility match with the donor was classified as D- (See text). A very transient rejection occurred after 1 month. This underwent almost immediate and complete remission. A late rejection which began on postoperative Day 72 was also easily controlled. Note the change in time scale after 4 months. The patient still has perfect liver function after 18 months. He is still receiving ALG. The normal enzyme values in international units at this age are: alkaline phosphatase, 57–151; SGOT, 3–27; and SGPT, 2–30.
Fig. 4
Fig. 4
A dog whose liver was replaced with the liver of a nonrelated mongrel donor in March 1964. Immunosuppressive therapy was with azathioprine alone. This drug was stopped after 4 months and the animal is in perfect condition more than 5 years later.
Fig. 5
Fig. 5
Hypothetical mechanisms by which nonspecific immunosuppression may lead to selective abrogation of the host immune response. Special susceptibility to these agents of a fraction of the lymphoid population could lead to exhaustion of a clone and, hence, tolerance. Since maintenance of such cell lines even in adult life is apparently thymus dependent in experimental animals, thymectomy would be expected to aid the process; this appears to be true in rodents, but such an effect of thymus removal has not been detected in dogs or humans. A possible protective role is also shown in immunoglobulins elaborated by the replicating cells. Conceivably the antibodies could act either at the site of the antigen (enhancement) or by affecting the macrophage processing of the antigen. See text for discussion.
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