Starzl's transplant work receives prestigious Lasker award
Lasker honor often considered precursor for Nobel
September 11, 2012 4:00 AM
Thomas E. Starzl, Pitt's pioneering liver transplant surgeon
By Mark Roth Pittsburgh Post-Gazette
Thomas Starzl can remember a time 60 years ago when patients who had failing livers, kidneys, hearts or lungs had very little hope.
"Until the advent of organ transplantation," Dr. Starzl said in an interview Monday, "people with end-stage organ failure could be offered little more than priestly comfort, and sometimes an operation that often was poorly conceived or even harmful."
And then, thanks to his work and that of a handful of others around the world, organ transplants became a reality, and today they offer lifesaving hope to hundreds of thousands of people around the globe.
For his pioneering contributions to that field, Dr. Starzl on Monday was named co-winner of the Lasker Foundation Clinical Medical Research Award, along with Sir Roy Calne of the University of Cambridge in England.
The shared $250,000 award will be handed out in a Sept. 21 ceremony in New York City.
Dr. Starzl, 86, who revolutionized the University of Pittsburgh medical school when he built up the organ transplant program here in the 1980s, performed some of the first successful kidney transplants when he was at the University of Colorado in the early 1960s and then performed the world's first successful liver transplant there in 1967.
When he came to Pittsburgh in the 1980s, he turned its university hospital system into a global powerhouse by championing the ever-expanding use of donated organs for transplant. He also pioneered two anti-rejection medications that sharply increased survival rates in patients -- cyclosporine and tacrolimus.
The new immunosuppressants, which kept patients' bodies from rejecting their transplanted tissue, turned organ transplants from a rare and risky experiment into almost routine clinical procedures. At its peak in the mid-1980s, Pitt's liver transplant program was so dominant that surgeons were performing almost a dozen procedures a week.
As Dr. Starzl blazed a trail in the United States, Dr. Calne, 81, forged a similar path in Great Britain, making organ transplantation more widely established there.
"We're talking about visionaries, both of them," said Goran Klintmalm, head of the Baylor Regional Transplant Institute in Texas, who trained with Dr. Starzl. "I think they complemented each other. They supported each other idea-wise and they both went through great strain" in the early, controversial days of transplants.
The Lasker Foundations awards often presage a Nobel Prize for their recipients, and are sometimes referred to as "America's Nobels."
While it may seem today that organ transplants have always been a part of the medical landscape, that was not always the case.
In the 1960s and 1970s, Dr. Starzl said, "there was a widespread conviction that the barriers to transplantation were so strong and unrelenting that transplantation was really not a biologically sound procedure, or might only be palliative."
And yet he and other early transplant pioneers persevered, until the operations reached the point where they offered real long-term survival hope to patients.
In the early years, though, when mortality rates were high, Dr. Klintmalm said, "you had to have a certain amount of ruthlessness to go through it. If you were too soft-hearted, you could never actually follow through. You had to have an armor around yourself, an ability to say, 'Let's try this,' and if it didn't work, you then had to leave that failure behind you and look forward."
In the 1980s, when Dr. Starzl was doing his highest volume of transplants, he was known for two paradoxical traits: his driving perfectionism in the operating room and his soft-hearted attachment to his patients, particularly children.
"He had an extraordinary ability to spot talent," Dr. Klintmalm said, "and if you didn't have that talent, you were out. He never taught the way other surgeons would; you worked with him and you'd better figure out the whys and hows, and if you didn't, it simply to him meant you didn't have what it took."
John Fung, head of the Digestive Disease Institute at the Cleveland Clinic, who worked with Dr. Starzl in Pittsburgh, said simply Monday that "he's a genius. I was fortunate to have been able to work with him for about 20 years, and even though I've worked with a lot of bright people, I've never seen anyone who had the intuition and ability to put so many things together."
After he retired from active surgery in the 1990s, Dr. Starzl devoted his energies to research, particularly a theory called microchimerism, to explain why patients' bodies were able to accept foreign tissue.
His idea -- controversial at first but now widely accepted -- was that cells from the donated organ infiltrate tissues and organs throughout the recipient's body, causing it to begin accepting the new tissue as its own.
Thinking back to those early days of little hope for people with end-stage organ failure, Dr. Starzl said "the arrival of transplantation changed the fundamental philosophy by which medicine was practiced, because now, when you reached that point of despair -- now the solution was just to change the failed engine out and put a whole new engine in."