PIONEERS OF LIVER TRANSPLANTATION: AN EXPANDED HISTORICAL REVIEW
From experimental canine grafts to living-donor and machine-perfusion eras, these innovators shaped modern hepatic transplantation.
FOUNDATIONAL ERA (1950s–1960s)
- Jack Cannon — early canine orthotopic liver transplants (UCLA, 1955).
- Francis D. Moore — metabolic physiology of transplantation; hepatic replacement in dogs (Harvard).
- Thomas E. Starzl — first human attempt (1963) and first long-term survivor (1967); defined perioperative management.
- Vladimir Demikhov — auxiliary graft experiments and cross-circulation models (USSR) influencing technique evolution.
Key Point: Technical feasibility came first; durable survival awaited immunologic breakthroughs.
IMMUNOSUPPRESSION & SURVIVAL ERA (1970s–1980s)
- Roy Y. Calne — azathioprine + steroids; clinical introduction of cyclosporine (late 1970s–80s).
- Thomas E. Starzl — integrated cyclosporine; later championed tacrolimus (FK506) protocols.
- John Wallwork — Cambridge refinements in surgical technique and immunosuppression synergy.
By 1983, one-year survival exceeded 60%; NIH designated liver transplantation “standard of care.”
TECHNICAL INNOVATORS (1980s–1990s)
- Henri Bismuth — reduced-size and segmental grafts; paved way for split-liver approaches.
- Jean Belghiti — split-liver and living-donor optimization in Paris.
- Russell W. Strong — first successful pediatric living-donor liver transplant (Brisbane, 1989).
- Christoph E. Broelsch — left-lateral segment grafts; donor safety protocols for pediatric LDLT.
- Andreas Tzakis — cluster/multivisceral transplantation (Pittsburgh) standardization.
Key Point: Segmental grafts and donor-safety advances unlocked transplantation for infants and expanded access.
MODERN ERA (2000s–PRESENT)
- Masatoshi Makuuchi — anatomical segmentectomy and adult-to-adult LDLT (right lobe).
- Shinji Uemoto — Kyoto LDLT protocols; exceptional survival benchmarks.
- John J. Fung — tacrolimus refinement, chronic rejection surveillance, tolerance research.
- Robert A. Fisher & Robert S. Brown Jr. — U.S. living-donor programs and MELD-based allocation impact.
- Machine perfusion teams — hypothermic/normothermic perfusion improving marginal graft utilization.
Frontiers include tolerance induction, cell therapies, and xenotransplantation trials grounded in decades of progress.
REFERENCES
- Moore FD, Demissianos HV, et al. Homotransplantation of the liver in dogs. Surgery. 1959;46:403–415.
- Starzl TE, et al. Experimental and clinical homotransplantation of the liver. Ann Surg. 1967;166:411–439.
- Calne RY, et al. Cyclosporin A: clinical organ grafting series. BMJ 1978; Lancet 1979–1981.
- Bismuth H, Houssin D. Reduced-size orthotopic liver transplantation. Surgery. 1984;95:367–370.
- Strong RW, et al. Living-related donor liver transplantation (Brisbane). Lancet. 1989;2:497–500.
- Broelsch CE, et al. Segmental liver transplantation in children and adults. Ann Surg. 1990;212:368–377.
- Tzakis AG, Todo S, Starzl TE. Cluster/multivisceral transplantation. Ann Surg. 1989;210:421–432.
- Makuuchi M, et al. Adult-to-adult LDLT using right lobe. Ann Surg. 1996;223:35–40.
- Uemoto S, et al. Living-donor liver transplantation in adults. Lancet. 1998;351:679–681.
- Fung JJ, et al. FK506 pharmacokinetics in liver transplantation. Transplant Proc. 1990;22:6–12.
- Brown RS, et al. Impact of MELD on allocation. Hepatology. 2004;39:476–483.
- Abecassis M, et al. Living donor liver transplantation—evolution and outcomes. Transplantation. 2012;93:975–983.