Pioneered Kidney Transplants, Then Made Them Routine

Thomas Starlz was a dynamo. He didn’t just go to medical school at Northwestern, he stayed an extra year to get a PhD in neurophysiology. Then went on to Johns Hopkins and became a surgeon, where he also conducted lab and animal research, and became intrigued by liver biology. His ten plus years of education was immediately put to good use in 1962 at the University of Colorado in the nascent field of organ transplantation.

Going back in history over a hundred years, the first organ transplantations had been skin grafts. They were rarely successful, which was eventually found to be due to organ rejection. Our body’s immune systems were developed by evolution to attack foreign bodies, since most are pathogens.

Even so, there was a huge need for transplantation. In WWII lots of soldiers received burns, so more research was done on skin grafts. In the 1950s there were hundreds of attempts to transplant kidneys, most unsuccessfully leading to death. You might think it would be unethical to attempt kidney transplants with so little chance of success. But at that time just having kidney failure was a death sentence. Dialysis existed, but could only be used a few times. So, a patient’s last chance was to try a kidney transplant. About the only ones that were successful were transplants between identical twins, since their immunes systems were usually compatible.

In 1963 a symposium was held by the National Research Conference in Washington DC. It was hoped that new immunosuppressant drugs might stop organ rejection and patients would survive. But scientist after scientist gave their presentation, using the new drugs, but citing failure after failure in their kidney transplants. The mood became so gloomy that some questioned if transplantation research should even continue.

And then an unknown newcomer to the research made his presentation. More than 70% of his kidney transplant patients lived more than a year. In fact, he had more surviving patients than the rest of the world’s famous transplant surgeon’s had combined!

There was an uproar. The other scientists couldn’t believe it. But Starlz presented charts detailing the daily progress of each patient, including lab tests, and urine output. The secret he revealed, he had learned reversing organ rejection when treating dogs. One of the new and popular anti-rejection drugs was azathioprine. Starlz had found that when it began to fail, if prednisone was added to it, the organ rejection could be halted. Prednisone is a steroid and can’t be taken forever, but Starlz found that once the rejection was halted, he could taper off the prednisone. It would turn out that some of Starlz patient’s lived another 50 years.

Transplant historian Nick Tilney describes Starlz presentation as “letting the genie out of the bottle.” Afterward, many scientists made a pilgrimage to the University of Colorado to learn Starlz’s protocols. Before the conference there were 3 kidney transplant centers in the U.S. Within a year there were 50. All of them used Starlz’s “cocktail immunosuppression.” This protocol stood for the next two decades. It also opened the possibility for other organ transplants. In fact, Starlz performed the first liver transplant later in 1963 and the first successful liver transplant in 1967.

Starlz went on to change his cocktail in 1982 with the advent of ciclosporin. Then he changed it again in 1991 with the advent of tacrolimus. Each time he perfected a cocktail using the new drug plus others to make it work, and each time other doctors took up his recipe for their transplants. He also introduced anti-lymphocyte globulin.

Kidney transplants have become almost routine now, with more than 100,000 being performed every year. 97% are successful for a year and 80% plus are successful for more than 5 years.

The Puzzle People: Memoirs of a Transplant Surgeon. 2003. Starlz’s acclaimed autobiography.

The Institute for Scientific Information released information in 1999 that documented that Starlz's journal articles had been cited more than any other researcher in the world. Between 1981 and June 1998, his scientific articles were cited 26,456 times.