The “prehistory” of organ transplantation began in the 19th century, and clinical transplantation might have begun in the 1920s, decades earlier than it did. Organ transplantation required surgical vascular anastomoses, achieved in the late 19th and early 20th centuries. Guthrie and Carrel showed from 1902 that autografts could function, and along with others attempted renal xenografts. But the main result of this activity was the emergence of the idea that some “biological incompatibility” caused their failure.
Its complexity was realized as the many components of the immune reaction were identified – particularly lymphocytes. Modification of this “bio-incompatibility” using benzol, gamma radiation and nitrogen mustard were rapidly described. Thus by the early 1920s, the possibility of organ transplantation with suppression of the reaction by chemical agents and/or irradiation became possible, but in fact were delayed for another 30 years. During the 1920s organ transplantation was hijacked by dubious practices, such as “monkey gland” testis xenografts. Work in the area was shunned as career-damaging for serious scientists.
In 1935 Voronoy first realized the potential of the newly-dead as cadaver donors, but all his grafts failed. Around 1950 transplantation again became a problem which surgeons were prepared to attack, principally in Boston and in Paris. Although all the 30+ grafts in the next 5 years failed, much was learned. Then as predicted by skin transfers, identical twins were transplanted – and succeeded. For other grafts no modification was used at first, but from 1958 radiation was used, new drugs such as corticosteroids then 6-MP and azathioprine were synthesized, and transplantation was launched.
Keywords: Renal transplantation, history of transplantation, immunology of transplantation