Transplant Pioneer Thomas E. Starzl Dies at 90

Megan Brooks

March 06, 2017

The "father of transplantation," Thomas E. Starzl, MD, PhD, died March 4 at the age of 90.

Dr Starzl was renowned for his role in "pioneering and advancing organ transplantation from a risky, rare procedure to an accessible surgery for the neediest patients," the University of Pittsburgh noted in a news release announcing his death.

"Tom Starzl was a man of unsurpassed intellect, passion and courage whose work opened up a new frontier in science and forever changed modern medicine. He will be remembered for many things, but perhaps most importantly for the countless lives he saved through his pioneering work. We at Pitt have lost a friend and colleague who took the University to new heights of recognition and achievement," Patrick Gallagher, chancellor of the University of Pittsburgh, said in the release.

Dr Starzl joined the University of Pittsburgh School of Medicine in 1981 as professor of surgery and led the team of surgeons who performed Pittsburgh's first liver transplant. Thirty liver transplants were performed that year, launching the university's liver transplant program – the only one in the United States at the time.

Until he retired from clinical and surgical practice in 1991, Dr Starzl served as chief of transplant services at Presbyterian University Hospital (now UPMC Presbyterian), the Children's Hospital of Pittsburgh (now the Children's Hospital of Pittsburgh of UPMC), and the Veterans Administration Hospital in Pittsburgh. He then assumed the title of director of the University of Pittsburgh Transplantation Institute, which was renamed the Thomas E. Starzl Transplantation Institute in 1996.

Dr Thomas Starzl overseeing a liver transplant at the University of Pittsburgh Medical Center in 1989. (Gene J. Puskar/AP)

"It's impossible to quantify the magnitude of his contributions to the field of transplant," said Abhinav Humar, MD, clinical director of the Thomas E. Starzl Transplantation Institute and chief of the Division of Transplantation in the Division of Surgery at UPMC, in the news release.

Part of an Elite Group That Pushed the Envelope

Dr Starzl performed the world's first liver transplant in 1963 and the first successful liver transplant in 1967, both while at the University of Colorado. Despite pessimism over the ability to transplant allogeneic human kidneys, he successfully combined azathioprine and corticosteroids in allogeneic kidney transplants performed in 1962 and 1963.

In 1980, Dr Starzl introduced antilymphocyte globulin and cyclosporine to prevent organ rejection, which advanced transplantation from an experimental procedure to an accepted form of treatment for patients with end-stage liver, kidney, and heart disease. It also led surgeons to explore the feasibility of transplanting other organs, such as the pancreas and lung.

Dr Starzl also pioneered the use of the antirejection agent FK506 (tacrolimus), which led to improved patient and graft survival rates for liver and other organ transplants and made intestinal transplantation possible for the first time.

There were a "handful of surgeons who pushed the envelope" in the 1960s and 1970s, and Tom Starzl was one of that "elite group of pioneers in surgery, and his field was liver transplantation," Milan Kinkhabwala, MD, chief of transplant surgery and director of abdominal organ transplantation, Montefiore Einstein Center for Transplantation, Montefiore Health System, New York City, said in an interview with Medscape Medical News.

"He introduced a lot of innovations in the organ transplant world, including the use of multiple drug regimens for rejection and the development of different surgical techniques that made liver transplantation much safer as an operation," said Dr Kinkhabwala. "He led the largest liver transplant program in the world at the University of Pittsburgh in the 1980s that trained countless surgeons that went out and kind of proliferated around the world and led to this operation being available for patients with liver failure all over the world."

Dr Starzl lobbied the federal government in the early 1980s to cover liver transplantation through Medicare and insurance companies, Dr Kinkhabwala noted.

"There is not a transplant surgeon worldwide who has not, in some way, been influenced by his work," Arthur S. Levine, MD, University of Pittsburgh senior vice chancellor for the health sciences and dean of the University of Pittsburgh School of Medicine, said in the news release.

Under Dr Starzl's leadership, the Thomas E. Starzl Transplantation Institute also researched the feasibility of xenotransplantation for addressing the chronic shortage of human organs. In 1992 and 1993, his team made history when they performed two baboon-to-human liver transplants.

A major focus of Dr Starzl's later research was transplant tolerance and chimerism – the existence of cells from both the donor and recipient. His work in this area led to significant contributions to the understanding of transplant immunology, particularly with respect to how and why organs are accepted.

Dr Starzl received more than 200 awards and honors, including the Lasker-DeBakey Clinical Medical Research Award from the Albert and Mary Lasker Foundation and the Presidential National Medal of Science, the nation's highest scientific honor. He held 26 honorary doctorates from universities around the world.

Dr Starzl was a member of more than 60 professional and scientific organizations around the world. He served as president of the Transplantation Society, founding president of the American Society of Transplant Surgeons, and founding president of the Transplant Recipients International Organization.

In 1992, he was inducted as one of only five American members into the prestigious National French Academy of Medicine. Dr Starzl gave more than 1300 presentations at major meetings around the world, belonged to the editorial boards of 40 professional publications, and authored or coauthored more than 2200 scientific articles, four books, and 300 book chapters.

According to the Institute for Scientific Information (ISI), Dr Starzl for a time averaged one paper every 7.3 days, making him one of the most prolific scientists in the world. In 1999, ISI identified him as the most cited scientist in the field of clinical medicine.

Dr Starzl's autobiography, The Puzzle People: Memoirs of a Transplant Surgeon, was published by the University of Pittsburgh Press in 1992. Translations have been published in Italian, Japanese, Korean, and Spanish, with all author's royalties donated to the Transplant Recipients International Organization.

Dr Starzl was born March 11, 1926, in LeMars, Iowa. He earned a bachelor's degree in biology, a master's degree in anatomy, a doctoral degree in neurophysiology, and a medical degree with distinction.

Dr Starzl is survived by his wife of 36 years, Joy Starzl, of Pittsburgh, son Timothy (Bimla), of Boulder, Colorado, and a grandchild, Ravi Starzl (Natalie), of Pittsburgh. He was preceded in death by a daughter, Rebecca Starzl, and a son, Thomas F. Starzl.

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