Transplantation milestones. Viewed with one- and two-way paradigms of tolerance

Abstract

TEN YEARS ago in this journal's Landmark Article series of reproduced historical publications, the remarkable impact was described¹of the 1956 report in<i>JAMA</i>by Merrill et al²of an identical twin renal transplantation. The operation was performed in December 1954, by Joseph E. Murray (Nobel Laureate, 1990) and his associates at the Peter Bent Brigham Hospital, Boston, Mass. By avoiding problems with rejection, such cases symbolized what might someday be accomplished if the immunologic reaction could be controlled. Then, on January 24, 1959, the barrier posed by genetic nonidentity was breached for the kidneys with a successful fraternal twin transplantation³by the same team. Over the ensuing 35 years, the beachhead has been expanded by the successful allotransplantation of the liver,⁴heart,⁵lung,⁶pancreas,⁷intestine,⁸multiple abdominal viscera,⁹and bone marrow.^10,11Such milestones are never eroded from the landscape, but