Twenty-Year Anniversary of University of Pittsburgh's First Liver Transplant Marks Two Decades of Major Advances
PITTSBURGH, February 23, 2001 — Twenty years ago, on February 26, a team of University of Pittsburgh surgeons led by transplant pioneer Thomas E. Starzl, M.D., Ph.D., performed the city's first liver transplant. Thirty liver transplants were performed that year, launching the university's liver transplant program -- the only one in the nation at the time -- and invigorating the university's heart and kidney transplant programs, which earned Pittsburgh the moniker "Transplant Capital of the World."
That year also served to spawn two decades of major advances by University of Pittsburgh faculty, the influence of which has impacted the entire field of transplantation. These have included the development of the immunosuppressant drug FK506, the refinement of small intestine transplantation and pivotal work on transplant tolerance and artificial organ research.
In 20 years, nearly 6,000 liver transplants and more than 11,300 transplants of all organs have been performed, a single-center experience unmatched by any other program. And many, if not most, of the world's transplant surgeons and physicians have passed through the University of Pittsburgh to receive training or have been trained by those who had.
“The efforts of Dr. Starzl, who is widely viewed as one of history's great physician scientists, were nothing short of heroic. They required unusual courage and unrelenting commitment, in addition to pioneering biological insights and unparalleled surgical skills. The extraordinary impact of Dr. Starzl's work can be seen in the fact that forms of organ transplantation that were viewed as medical miracles just twenty years ago, now are an accepted part of medical practice throughout the country and around the world. Organ transplantation also played a central role in the broader and highly successful efforts of the University of Pittsburgh and the University of Pittsburgh Medical Center to establish western Pennsylvania as a center of world-class medical science and patient care,” said University of Pittsburgh Chancellor Mark A. Nordenberg.
Dr. Starzl came to the University of Pittsburgh in 1981 from the University of Colorado, where in 1963 he performed the world's first liver transplant, and in 1967, the first successful liver transplant. When he came to Pittsburgh, he brought with him the drug cyclosporine, which advanced transplantation from an experimental procedure to an accepted form of treatment for patients with end-stage diseases of the liver, kidney and heart. It also allowed surgeons to explore the feasibility of transplanting other organs, such as the lung and pancreas.
Henry Bahnson, M.D., then chairman of the department of surgery at the University of Pittsburgh School of Medicine, recruited Dr. Starzl. A transplant surgeon himself, Dr. Bahnson had performed a heart transplant at the University of Pittsburgh in 1968, one of the first to do so in the United States. Because drugs were not yet available that could yield acceptable survival rates, Dr. Bahnson closed the program until 1980. That year, Pittsburgh was one of only a few centers to perform heart transplants.
When Dr. Starzl arrived in Pittsburgh, the university already had an established kidney transplant program led by Thomas Hakala, M.D., who had also been instrumental in developing a system to procure donated organs for transplantation.
In many ways, the University of Pittsburgh had the mindset, medical expertise and appropriate resources to build a first-rate transplant program. But when the first handful of liver transplants performed in Pittsburgh were not successful, even those working closely with Dr. Starzl were somewhat skeptical.
"Many people thought we should stop, and the failures were reported in a glare of negative publicity. But when you have seen someone on the brink of death fully recover from transplantation, as I had in Colorado, I knew exactly what I was going to do. Press on," reflects Dr. Starzl, professor of surgery and director emeritus of the University of Pittsburgh Thomas E. Starzl Transplantation Institute .
Dr. Starzl's first liver transplant in Pittsburgh took place on Feb. 26, 1981 at Presbyterian-University Hospital (now UPMC Presbyterian). The 56-year-old man died about three weeks later. Three more transplants were performed in three adults, all of whom died within days or weeks. Not until May 9, with the transplant of two-year-old Todd McNeely at Children's Hospital of Pittsburgh, did the team meet with success. Now 20 years later, he is still alive, as are six other children and four adults of the 30 transplanted that year.
The team's first successful adult was 26-year-old Thomas Burke, who was transplanted July 12, 1981. He is among those still doing well.
"The experience for everyone -- patients, families, staff -- was so intense, because at the time the odds were against patients to survive. I think that's why the details of those early patients are so vivid," observes Sandra Staschak-Chicko, B.S.N., R.N., CCTC, who was the sole nurse coordinator for the program. Today, she is director of development for the Thomas E. Starzl Transplantation Institute.
Pittsburgh was the only center performing liver transplants that year and one of only a few centers to perform heart transplants. And with no nationally organized system of organ procurement, surgeons and organ procurement professionals often had to place calls to friends working in hospitals around the country seeking potential donors for patients on the waiting list, which numbered less than 100 at the time. There are currently about 1,500 patients listed for various types of transplants at the University of Pittsburgh, and the procurement of organs has evolved into a sophisticated national network of 59 organ procurement organizations (OPOs).
"It has been exciting to influence and be a part of the changes over the years," notes Brian A. Broznick, president and CEO of the Center for Organ Recovery & Education, the OPO that serves western and central Pennsylvania, West Virginia and part of New York, and which is considered one of the most innovative OPOs in the world.
"At one point, in 1982, we found it necessary to install a 24-hour telephone message system -- basically an answering machine -- that provided information about the needs of our most urgent patients. We've certainly come a long way since then," adds Broznick, who as part of the then Transplant Organ Procurement Foundation of Western Pennsylvania, had been instrumental in helping to offer families the option for organ donation that ultimately would aid patients in the Pittsburgh transplant program.