Sur­geon’s pi­o­neer­ing work saved thou­sands

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Dr. Thomas Starzl, who pi­o­neered liver trans­plant surgery in the 1960s and was a lead­ing re­searcher into anti-re­jec­tion drugs, has died. He was 90.

The Univer­sity of Pitts­burgh, speak­ing on be­half of Starzl’s fam­ily, said the renowned doc­tor died Satur­day at his home in Pitts­burgh.

Starzl per­formed the world’s first liver trans­plant in 1963 and the world’s first suc­cess­ful liver trans­plant in 1967, and pi­o­neered kid­ney trans­plan­ta­tion from ca­dav­ers. He later per­fected the process by us­ing iden­ti­cal twins and, even­tu­ally, other blood rel­a­tives as donors.

Since Starzl’s first suc­cess­ful liver trans­plant, thou­sands of lives have been saved by sim­i­lar op­er­a­tions.

“We re­gard him as the fa­ther of trans­plan­ta­tion,” said Dr. Ab­hi­nav Hu­mar, clin­i­cal di­rec­tor of the Thomas E. Starzl Trans­plan­ta­tion In­sti­tute. “His legacy in trans­plan­ta­tion is hard to put into words — it’s re­ally im­mense.”

Starzl joined the Univer­sity of Pitts­burgh School of Medicine in 1981 as pro­fes­sor of surgery, where his stud­ies on the anti-re­jec­tion drug cy­closporin trans­formed trans­plan­ta­tion from an ex­per­i­men­tal pro­ce­dure into one that gave pa­tients a hope they could sur­vive an oth­er­wise fa­tal or­gan fail­ure.

It was Starzl’s devel­op­ment of cy­closporin in com­bi­na­tion with steroids that of­fered a so­lu­tion to or­gan re­jec­tion.

Un­til 1991, Starzl served as chief of trans­plant ser­vices at UPMC, then was named di­rec­tor of the Univer­sity of Pitts­burgh Trans­plan­ta­tion In­sti­tute, where he con­tin­ued re­search on a process he called chimerism, based on a 1992 paper he wrote on the the­ory that new or­gans and old bod­ies “learn” to co-ex­ist with­out im­muno­su­pres­sion drugs.

The in­sti­tute was re­named in Starzl’s honor in 1996, and he con­tin­ued as its di­rec­tor.

In his 1992 au­to­bi­og­ra­phy, “The Puz­zle Peo­ple: Mem­oirs of a Trans­plant Sur­geon,” Starzl said he hated per­form­ing surgery and was sick­ened with fear each time he pre­pared for an op­er­a­tion.

“I was striv­ing for lib­er­a­tion my whole life,” he said in an in­ter­view.

Starzl’s in­ter­est in re­search be­gan with a liver op­er­a­tion he as­sisted on while a res­i­dent at Johns Hop­kins Hos­pi­tal in Bal­ti­more. Af­ter the surgery to re­di­rect blood flow around the liver, he no­ticed the pa­tient’s sugar di­a­betes also had im­proved.

Think­ing he had found the cause of di­a­betes to be in the liver rather than the pan­creas, he de­signed ex­per­i­ments in 1956 with dogs to prove his dis­cov­ery. He was wrong, but he had started on the path that would lead to the first hu­man liver trans­plants at the Univer­sity of Colorado in Den­ver seven years later.

In the early 1990s, liv­ers from ba­boons were transplanted into hu­mans, an op­er­a­tion made pos­si­ble by Starzl’s re­search into al­ter­na­tives to scarce hu­man liv­ers.

Starzl’s other ac­com­plish­ments in­cluded in­vent­ing a way to route the blood sup­ply around the liver dur­ing surgery to make pos­si­ble the marathon hours re­quired to com­plete op­er­a­tions in­volv­ing that com­plex or­gan.

He also showed that “sol­dier cells” from the transplanted or­gan be­come “mis­sion­ary cells” that travel through­out the new body and find new homes, ap­par­ently help­ing the body ac­cept the for­eign or­gan.

Starzl helped de­velop with Dr. John Fung, his pro­tege at UPMC and suc­ces­sor as di­rec­tor of trans­plant surgery, the use of the ex­per­i­men­tal anti-re­jec­tion drug FK506, which paved the way to more com­pli­cated trans­plants of mul­ti­ple or­gans, in­clud­ing the dif­fi­cult small in­tes­tine. FK506 was dis­cov­ered in a soil sam­ple by Ja­panese re­searchers.

In Septem­ber 1990, at age 65, Starzl put away his scalpel for good, soon af­ter the death of a fa­mous young pa­tient: a 14-year-old girl from White Set­tle­ment, Texas, named Stormie Jones. Stormie lived six years af­ter a com­bi­na­tion heart-liver trans­plant at age 8 but needed a sec­ond liver in 1990 and died within nine months. Her death af­fected Starzl greatly.

“It is true that trans­plant sur­geons saved pa­tients, but the pa­tients res­cued us in turn and gave mean­ing to what we did, or tried to,” he once wrote.

AP 1989

Dr. Thomas Starzl per­formed the world’s first liver trans­plant in 1963 and con­tin­ued to do ground­break­ing work for decades.

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