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In 1981, Pittsburgh's Dr. Thomas Starzl saw the future of transplants
Saturday, February 24, 2001 By Anita Srikameswaran, Post-Gazette Staff Writer
In an April 1981 letter to Dr. Henry Bahnson, at the time chairman of surgery for the University of Pittsburgh School of Medicine, Dr. Thomas Starzl shared his expectations for the then-new field of organ transplantation.
"There will be a change in the way we practice medicine," he predicted. "It is electrifying to envision the way in which cardiology, endocrinology, hepatology, and gastroenterology (as well as nephrology) can be affected if various organs in otherwise well patients can be reliably replaced."
At the time, Starzl had performed three liver transplants in Pittsburgh. All the patients had died within days or weeks of their operations.
And cyclosporine was an experimental anti-rejection drug with a bad reputation.
Monday marks the 20th anniversary of Pittsburgh's first liver transplant, a 56-year-old man who died three weeks later. But by the end of 1981, Starzl's first year in Pittsburgh, he and the transplant team had performed 30 liver transplant operations and were on their way to making the city the so-called "Transplant Capital of the World."
Since then, more than 5,700 liver, 3,500 cadaveric kidney, 1,000 heart and 500 lung transplants have been done at the medical center, along with many small bowel, pancreas and multiple-organ transplants.
Starzl persevered because of his successes at the University of Colorado, where he performed the world's first liver transplant.
"We had already done approximately 170 liver transplants in Denver beginning in March 1963," he said yesterday at a news conference. "About one-third of those patients had survived the operation and lived for one year."
One of them has now lived for 31 years since her transplant. Many others have survived for more than 20 years.
That's the milestone that Todd McNeely will achieve on May 9.
He was 2 when he received a liver transplant at Children's Hospital. The network of bile ducts in his own liver hadn't developed properly, a condition called biliary atresia.
His mother, Linda McNeely, who lives in Nashville, said that prior to the operation, Todd's belly was distended with fluid, his skin was yellow and his breathing was labored. The transplant team hadn't recorded any successes in Pittsburgh, but the decision to go ahead with the operation came easily.
"That was his only chance," Linda McNeely said. "I was very determined that he would at least have the chance and have the transplant. Otherwise, there was no hope."
The boy did spectacularly well. His mother remembered that he was running around a week after the transplant. He went home taking steroids and cyclosporine, which was then an experimental anti-rejection drug. When he was in junior high school, he was weaned off the medications.
The liver disease, though, did stunt his growth as a toddler.
"He seems to have caught up, because now he's 6 feet tall and weighs 220 pounds," said his mother. "He works out daily at the gym." Now 22, Todd McNeely will graduate with honors in finance this spring at Auburn College.
Thomas Burke received a liver transplant on July 12, 1981, and became the Pittsburgh team's first success in an adult patient.
He was 26 when severe abdominal cramps forced him to a New Jersey emergency room. To his surprise, the doctors kept him in the hospital for further tests. A week later, he was told he had a liver tumor that needed to be removed. Family friends told Burke to go see a surgeon in Pittsburgh named Starzl.
But once he saw the tumor on Burke's liver, the surgeon called off the operation. Too much of the liver would have to be removed to take out the tumor, and there was no chance that Burke would survive. The next day, Starzl told the young man that a liver transplant was the best option.
"I had no clue" that the success rate was poor, Burke said in a phone interview. "I didn't even think to ask. Quite honestly, I'd never heard of it before, so to me it therefore seemed like, well, this won't be such a big deal."
Burke didn't realize how uncommon his survival was until he asked why the nurses were throwing a party for his departure from the hospital about four weeks after his operation.
"That's when I found out it was because they hadn't had many successes," he said. "I was kind of flabbergasted."
Burke, now a 46-year-old husband and father, is on a small dose of cyclosporine and has remained in good health since the operation.
A lot has changed since his and McNeely's transplants, including the way organs are procured and distributed and how operation costs are covered.
When Dr. Stephan Sher's wife, Susan, had her liver transplant on Sept. 14, 1982, the database of potential donors was a 3-by-5-inch card in the shirt pocket of nurse Sandra Staschak-Chicko's scrubs. Word of mouth and phone calls were the way donors and recipients were put together.
The rules about who is eligible for a transplant have also changed, noted Dr. John Fung, director of UPMC's Starzl Transplantation Institute. Now, a patient like Burke who had a large liver cancer may not be considered an appropriate candidate for a scarce organ.
"We would consider him because we're a little more aggressive," Fund said. "But nationwide, a patient like him wouldn't get on the list."
And since 1984, Medicare and insurance companies have routinely covered transplant costs.
Although he believed all along that organ transplantation would work, the architect himself is surprised and delighted by its success at allowing deathly ill people a chance for a fulfilling life.
"The field became more beautiful than I thought it ever would be or could be," Starzl said.
Transplant recipients are "doing everything that everyone else does. And when they get this far out, they have a normal life expectancy. We can look forward to our patients outliving us."
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