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Celebrating 50 Years of Kidney Transplantation

Surgery

The 1968 transplant and immunology team

 Celebrating 50 years of Kidney Transplantation 

On December 3, 1968, the Medical College of South Carolina performed the first major organ transplant in its history and the first in the state. The kidney transplant was performed by a team of doctors and researchers who developed an innovative procedure that addressed the body’s rejection of foreign matter.

Overcoming the Rejection Factor

Knowledge of the rejection factor was extremely limited at the time of the 1968 operation. Curtis P. Artz, M.D. chair of the department, had studied the role that lymphocytes played in transplanted organ rejection. His work led his colleagues at MUSC to pursue research into lymphocyte depletion in animals. The Kidney Transplant and Immunology Team consisted of C. Thomas Fitts, M.D. assistant professor of surgery, Fletcher C. Derrick, Jr., M.D. assistant professor of urology, James S. Harvin, M.D. chief of plastic surgery, Lloyd L. Martin, supervisor of the Department of Surgery Research Laboratory, H. Biemann Othersen, Jr., M.D. assistant professor of pediatric surgery, Arthur V. Williams, M.D. chief of the renal section of the Department of Medicine, Charles Graber, M.D. associate professor of microbiology, and Thomas S. Hargest, III, assistant professor of surgery, bioengineering.

A Patient Identified

The patient, William Ashley, was a 24-year-old man who suffered from chronic glomerulonephritis. After months of laboratory work to perfect the operational technique and compiling evidence to indicate the ability to deplete these lymphocytes enough to lessen the rejection process, the transplant team decided that Ashley’s best chance of avoiding the risks of tissue rejection was through a newly discovered process known as lymphocyte depletion.

The Operation

All of the medical professionals involved brought expertise and experience and the operation was a success. What made this operation unique was the use of lymphocyte depletion as the principal pre-operative measure against organ rejection. No anti-serum or drugs were used before or during the transplant.

Two Decades of Growth

C. Thomas Fitts, M.D.recognized as the creator of the MUSC Health organ transplant program, led the transplant section for 39 years. He served as director of Transplant Surgery and director of the Transplant Program.

P.R. Rajagopalan, M.D. commonly referred to as Dr. Raja, attended MUSC as a transplant fellow in 1974 and joined Fitts in 1975, spending the next 25 years building and strengthening the foundation of the vascular-access program and the kidney-pancreas transplant programs. From his early years, Raja has been committed to innovation and progress in the field of transplantation. For the first two years at MUSC, Raja worked primarily on establishing a donor program. In the first year, he secured 10 donors and set the stage for the program to grow.

Under his leadership, the program grew in large part due to his commitment to formalize the organ procurement process in South Carolina. “At the time, there was no organ procurement organization in South Carolina,” said Raja. “Establishing an OPO in South Carolina was critical to the success of our program. OPOs are effective third party affiliates that are vital to connecting the donor families and recipients. Not only did we establish one for South Carolina, ours has one of the highest levels of patient consent.”By the 1980s, the transplant team entered a portal of endless possibilities in technology, medications and patient education, making kidney transplant an efficient, sound and established procedure. During the next two decades, kidney transplantation changed dramatically.

Fred Crawford, M.D. then chairman of the department, led the initiative to expand the kidney program to a multi-organ transplant program. Recruitment of individuals with expertise in transplantation and research continued.

In 1992, Prabhakar Baliga, M.D. joined the team and provided expertise in pediatric transplantation, adding strength and depth to the organ transplant program, which now included kidney, liver, pancreas, and heart.Shortly after Baliga’s arrival, Fitts retired and Raja was selected as chief of the Section of Transplant Surgery. A few years later, Ken Chavin, M.D., Ph.D. joined the transplant team, bringing with him the ability to perform minimally invasive surgery via laparoscopic nephrectomy. This new procedure increased the number of living transplants at MUSC. By 1999, Raja stepped down as head of the transplant section and Baliga was named the chief of transplant surgery. Raja officially retired in 2013.

Y2K and Beyond

As we entered the new millennium, exciting changes were occurring – starting with the transplant section becoming a full service division. The team grew as well. Angello Lin, M.D. joined in 2000 and Charles Bratton, M.D. joined shortly after Lin.

In 2002, Baliga was awarded his first NIH R01 grant. In 2007, the division was awarded National Kidney Foundation Center of Excellence status in kidney transplantation. That same year, John McGillicuddy, M.D. joined the division and subsequently received an NIH-K research award. The Division of Transplant Surgery recruited David Taber, Pharm.D., to conduct research on patient outcomes.

Satish Nadig, M.D., Ph.D. also joined, bringing new levels of collaboration,innovation and funding opportunities to the division.By 2011, the division celebrated a new milestone: The first endowed chair in the division was funded. The Fitts-Rajagopalan Chair was awarded to Dr. Baliga during a dinner. That same evening, Dr. Raja was awarded the Order of the Palmetto, South Carolina’s highest civilian honor, recognizing his lifetime achievements and contributions to the State of South Carolina.

The Living Donor Institute was created to study innovative methods of health care delivery and provide patient and community education with the goal of improving the patient care experience, access to transplantation and improvement in long-term patient outcomes.

When Baliga was named the department chair in 2015, he recruited Derek DuBay, M.D. to lead the division.DuBay, an expert in solid organtransplantation, is building thedivision to address the growing need for organ transplantation in South Carolina. DuBay expanded access to kidney transplantation through telemedicine and secured a Duke Endowment to fund research to reduce disparities in access to kidney transplantation in South Carolina, a state with one of the highest incidences of kidney failure in the country due to the frequency of diabetes and hypertension. Volume steadily increased.

By 2017, MUSC ranked 10th in the country for kidney transplants. Vinayak Rohan, M.D. joined the team after completing his transplant fellowship and MUSC surgery residency.

Research opportunities grew when the Lee Patterson Allen Transplant in Immunobiology Laboratory became a reality through the generous donation from family members of Lee Patterson Allen, who donated a half million dollars to support the Lab’s work. The lab represents the only comprehensive transplant research laboratory in South Carolina and is focused on all aspects of multi-organ transplantation from donor management to recipient survival. Using a multidisciplinary approach, including the application of bioengineering to transplant immunology, the laboratory is dedicated to representing the leading edge in transplantation. Satish Nadig, M.D., Ph.D. and Carl Atkinson, Ph.D. lead the effort as co-directors.

For 50 years, beginning with the innovative, living donor transplant in 1968, the MUSC Health transplant surgeons and scientists continue to innovate and collaborate to create better patient outcomes, improving the lives of those in need of organ transplantation.

Editor's note: Content courtesy of the Waring Historical Library, MUSC, Charleston, SC. and “Approaching Two Centuries” by Fred A. Crawford, Jr.