Keith Reemtsma (5 December 1925 – 23 June 2000) was an American
transplant surgeon, best known for the
cross-species kidney transplantation operation from chimpanzee to human in 1964. With only the early
immunosuppressants
Immunosuppressive drugs, also known as immunosuppressive agents, immunosuppressants and antirejection medications, are drugs that inhibit or prevent activity of the immune system.
Classification
Immunosuppressive drugs can be classified int ...
and no long-term
dialysis, the female recipient survived nine months, long enough to return to work.
Reemtsma was brought up on a
Navajo
The Navajo (; British English: Navaho; nv, Diné or ') are a Native American people of the Southwestern United States.
With more than 399,494 enrolled tribal members , the Navajo Nation is the largest federally recognized tribe in the United ...
reservation in
Arizona
Arizona ( ; nv, Hoozdo Hahoodzo ; ood, Alĭ ṣonak ) is a state in the Southwestern United States. It is the 6th largest and the 14th most populous of the 50 states. Its capital and largest city is Phoenix. Arizona is part of the Fou ...
, eventually moving to
Utah
Utah ( , ) is a state in the Mountain West subregion of the Western United States. Utah is a landlocked U.S. state bordered to its east by Colorado, to its northeast by Wyoming, to its north by Idaho, to its south by Arizona, and to it ...
and then graduating from
Idaho State College
, mottoeng = "The truth will set you free"
, established =
, former_names = Academy of Idaho(1901–1915)Idaho Technical Institute(1915–1927)University of Idaho—Southern Branch(1927–1947)Idaho State ...
in
Pocatello
Pocatello () is the county seat of and largest city in Bannock County, with a small portion on the Fort Hall Indian Reservation in neighboring Power County, in the southeastern part of the U.S. state of Idaho. It is the principal city of the P ...
in 1945. In the 1960s he was professor of surgery at
Tulane University, Louisiana and he later became chairman of the Department of Surgery at the
University of Utah
The University of Utah (U of U, UofU, or simply The U) is a public research university in Salt Lake City, Utah. It is the flagship institution of the Utah System of Higher Education. The university was established in 1850 as the University of De ...
.
Reemtsma also developed the
intra-aortic balloon pump
The intra-aortic balloon pump (IABP) is a mechanical device that increases myocardial oxygen perfusion and indirectly increases cardiac output through afterload reduction. It consists of a cylindrical polyurethane balloon that sits in the aorta ...
to bridge the time to
heart transplant
A heart transplant, or a cardiac transplant, is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease when other medical or surgical treatments have failed. , the most common procedu ...
, and performed early research on
pancreatic
The pancreas is an organ of the digestive system and endocrine system of vertebrates. In humans, it is located in the abdomen behind the stomach and functions as a gland. The pancreas is a mixed or heterocrine gland, i.e. it has both an endocr ...
islet cell transplantation
Islet transplantation is the transplantation of isolated islets from a donor pancreas into another person. It is an experimental treatment for type 1 diabetes mellitus. Once transplanted, the islets begin to produce insulin, actively regulating th ...
for
diabetes mellitus
Diabetes, also known as diabetes mellitus, is a group of metabolic disorders characterized by a high blood sugar level ( hyperglycemia) over a prolonged period of time. Symptoms often include frequent urination, increased thirst and increased ap ...
. In 1971, he was appointed chairman of the Department of Surgery at
NewYork–Presbyterian Hospital The NewYork-Presbyterian Hospital is a nonprofit academic medical center in New York City affiliated with two Ivy League medical schools, Cornell University and Columbia University. The hospital comprises seven distinct campuses located in the New Y ...
and
Columbia University College of Physicians and Surgeons
Columbia University Vagelos College of Physicians and Surgeons (VP&S) is the graduate medical school of Columbia University, located at the Columbia University Irving Medical Center in the Washington Heights neighborhood of Manhattan. Founded i ...
, where he was involved in developing a multidisciplinary approach to transplant services, as well as advocating surgical repair and reconstruction as an alternative to radical excision.
Early life
Reemtsma was born in
Madera, California
Madera (Spanish language, Spanish for "Wood") is a city and county seat of Madera County, California, Madera County, California. As of the 2020 United States census, the city's population was 66,224.
Located in the San Joaquin Valley, Madera i ...
, on 5 December 1925, to the Presbyterian minister and missionary Henry and Pauline Reemtsma. He had one older sister, Carol, and from 1938 was raised on a Navajo reservation in Arizona when he attended a one-room school house which taught only to eighth grade.
As he progressed in his education, he moved from schools in
Oklahoma
Oklahoma (; Choctaw language, Choctaw: ; chr, ᎣᎧᎳᎰᎹ, ''Okalahoma'' ) is a U.S. state, state in the South Central United States, South Central region of the United States, bordered by Texas on the south and west, Kansas on the nor ...
to a Presbyterian boarding school in
Mount Pleasant, Utah
Mount Pleasant is a city in the U.S. state of Utah. Located in Sanpete County, Mt. Pleasant is known for its 19th-century main street buildings, for being home to Wasatch Academy, and for being the largest city in the northern half of the count ...
, where he met his first wife to be, Ann Pierce.
He attended
Idaho State College
, mottoeng = "The truth will set you free"
, established =
, former_names = Academy of Idaho(1901–1915)Idaho Technical Institute(1915–1927)University of Idaho—Southern Branch(1927–1947)Idaho State ...
as part of the
United States Navy
The United States Navy (USN) is the maritime service branch of the United States Armed Forces and one of the eight uniformed services of the United States. It is the largest and most powerful navy in the world, with the estimated tonnage ...
V-12 programme, where the federal government funded studies to participating colleges. Here, wearing
Navy uniform was mandatory and he would have had to participate in strenuous exercise.
He completed his pre-medical studies and graduated in 1945.
Reemtsma subsequently attended the
University of Pennsylvania School of Medicine
The Perelman School of Medicine, commonly known as Penn Med, is the medical school of the University of Pennsylvania, a private research university in Philadelphia, Pennsylvania. Founded in 1765, the Perelman School of Medicine is the oldest medi ...
, graduating in 1949, and was inducted into the
Phi Chi Medical Fraternity
(''Phthomen Chraismein'') en, First to Serve
, colors= Olive green & white
, symbol= Adult Tiger Beetle (''Cicindela patruela''), Doodlebug
, flower= Lily of the Valley
, publication= ''The Chronicles''; formerly ''The Quarterly''
, chapters= 1 ...
.
Early surgical training
Reemtsma trained under paediatric surgeon
C. Everett Koop
Charles Everett Koop (October 14, 1916 – February 25, 2013) was an American pediatric surgeon and public health administrator. He was a vice admiral in the U.S. Public Health Service Commissioned Corps, and served as the 13th Surgeon Ge ...
who encouraged him to go to Columbia-Presbyterian Medical Center (CPMC) (now called
NewYork–Presbyterian The NewYork-Presbyterian Hospital is a nonprofit academic medical center in New York City affiliated with two Ivy League medical schools, Cornell University and Columbia University. The hospital comprises seven distinct campuses located in the New Y ...
/
Columbia University Medical Center
NewYork-Presbyterian/Columbia University Irving Medical Center (NYP/CUIMC), also known as the Columbia University Irving Medical Center (CUIMC), is an academic medical center and the largest campus of NewYork-Presbyterian Hospital. It includes C ...
or, simply NYP/Columbia) for his surgical residency, under paediatric thoracic surgeon, George Humphreys.
Following his internship, his early surgical career was interrupted by the
Korean War
, date = {{Ubl, 25 June 1950 – 27 July 1953 (''de facto'')({{Age in years, months, weeks and days, month1=6, day1=25, year1=1950, month2=7, day2=27, year2=1953), 25 June 1950 – present (''de jure'')({{Age in years, months, weeks a ...
, where he served as a Navy doctor with the
United States Marine Corps
The United States Marine Corps (USMC), also referred to as the United States Marines, is the maritime land force service branch of the United States Armed Forces responsible for conducting expeditionary and amphibious operations through combi ...
with surgeon
Frank Spencer as part of
US Navy Surgical Team, Far East Command.
Returning to New York in 1954, he then completed his residency at CPMC in 1957, following which he moved south to Tulane University. Here, under
Oscar Creech
Oscar, OSCAR, or The Oscar may refer to:
People
* Oscar (given name), an Irish- and English-language name also used in other languages; the article includes the names Oskar, Oskari, Oszkár, Óscar, and other forms.
* Oscar (Irish mythology) ...
, Reemtsma was recruited to help build a cardiac surgery service. However, he turned his attention toward renal transplantation and cross-species chimpanzee-to-human kidney transplants instead.
Surgical career
Xenotransplantation
Prior to the 1960s, long term kidney dialysis was not available, human donors were scarce and immunosuppressants were basic.
Unlike centers in Denver and Cleveland, dialysis support came to Reemtsma's center much later, and
Cyclosporine
Ciclosporin, also spelled cyclosporine and cyclosporin, is a calcineurin inhibitor, used as an immunosuppressant medication. It is a natural product. It is taken orally or intravenously for rheumatoid arthritis, psoriasis, Crohn's disease ...
was not available for use in people until the late 1970s.
In addition, an increasing understanding of the immunological basis of organ rejection, the "clinical urgency"
of the time, and the ethical and legal hurdles in obtaining donor organs, whether cadaveric or live, led to a desperation.
This, combined with Reemtsma's belief in that the lack of previous successful attempts should not deter innovation,
led him to explore the possibility of primate-to-human transplantation. The availability of primates from the nearby primate center and an active programme in transplantation immunology, added to his plans.
Between 5 November 1963 and 10 February 1964,
whilst professor of surgery at
Tulane University
Tulane University, officially the Tulane University of Louisiana, is a private university, private research university in New Orleans, Louisiana. Founded as the Medical College of Louisiana in 1834 by seven young medical doctors, it turned into ...
, Louisiana, Reemtsma performed a series of chimpanzee-to-human
kidney transplants
Kidney transplant or renal transplant is the organ transplant of a kidney into a patient with end-stage kidney disease (ESRD). Kidney transplant is typically classified as deceased-donor (formerly known as cadaveric) or living-donor transplantati ...
.
He posited that nonhuman primate kidneys might function in human recipients and therefore be a successful treatment for
renal failure
Kidney failure, also known as end-stage kidney disease, is a medical condition in which the kidneys can no longer adequately filter waste products from the blood, functioning at less than 15% of normal levels. Kidney failure is classified as eit ...
, the alternative being death.
Chimpanzee kidneys appealed because of their size and shared blood groups (
A and O blood groups) with humans.
Retired from space-flight or the circus, bad-tempered or no longer wanted, both kidneys from six chimpanzees were transplanted into six people who had terminal renal failure,
using the 'en bloc' technique, where the two kidneys with their accompanying blood vessels (including
aorta
The aorta ( ) is the main and largest artery in the human body, originating from the left ventricle of the heart and extending down to the abdomen, where it splits into two smaller arteries (the common iliac arteries). The aorta distributes ...
and
vena cava
In anatomy, the venae cavae (; singular: vena cava ; ) are two large veins (great vessels) that return deoxygenated blood from the body into the heart. In humans they are the superior vena cava and the inferior vena cava, and both empty into the ...
) were implanted and
joined to the recipient's
external iliac artery
The external iliac arteries are two major arteries which bifurcate off the common iliac arteries anterior to the sacroiliac joint of the pelvis.
Structure
The external iliac artery arises from the bifurcation of the common iliac artery. Th ...
and
external iliac vein.
Anti-rejection medication after the operation included actinomycin C,
corticosteroids and
x-ray irradiation.
Most survived between just over one week to two months, failure being due to
organ rejection
Transplant rejection occurs when transplanted tissue is rejected by the recipient's immune system, which destroys the transplanted tissue. Transplant rejection can be lessened by determining the molecular similitude between donor and recipient a ...
or post-operative infection (usually due to the immunosuppressants).
One female school teacher, admitted with chronic
glomerulonephritis
Glomerulonephritis (GN) is a term used to refer to several kidney diseases (usually affecting both kidneys). Many of the diseases are characterised by inflammation either of the glomeruli or of the small blood vessels in the kidneys, hence the ...
and severe
uraemia
Uremia is the term for high levels of urea in the blood. Urea is one of the primary components of urine. It can be defined as an excess of amino acid and protein metabolism end products, such as urea and creatinine, in the blood that would be nor ...
in November 1963 at the age of 23, had the chimpanzee kidney transplant procedure performed on 13 January 1964.
She remained on immunosuppressants
azathioprine
Azathioprine (AZA), sold under the brand name Imuran, among others, is an immunosuppressive medication. It is used in rheumatoid arthritis, granulomatosis with polyangiitis, Crohn's disease, ulcerative colitis, and systemic lupus erythematosus, ...
and
prednisolone
Prednisolone is a steroid medication used to treat certain types of allergies, inflammatory conditions, autoimmune disorders, and cancers. Some of these conditions include adrenocortical insufficiency, high blood calcium, rheumatoid arthrit ...
,
and lived to return to work and survive nine months.
Her death from
cardiac arrest
Cardiac arrest is when the heart suddenly and unexpectedly stops beating. It is a medical emergency that, without immediate medical intervention, will result in sudden cardiac death within minutes. Cardiopulmonary resuscitation (CPR) and possib ...
was found to be due to an imbalance of
electrolyte
An electrolyte is a medium containing ions that is electrically conducting through the movement of those ions, but not conducting electrons. This includes most soluble salts, acids, and bases dissolved in a polar solvent, such as water. Upon dis ...
s, possibly due to the
excessive urination
Frequent urination is the need to urinate more often than usual. Diuretics are medications that will increase urinary frequency. Nocturia is the need of frequent urination at night. The most common cause of urinary frequency for women and childre ...
observed following chimpanzee kidney transplantation (frequently greater than 20 liters per day), as the chimpanzee kidneys probably did not work in precisely the same way as human kidneys.
At
autopsy
An autopsy (post-mortem examination, obduction, necropsy, or autopsia cadaverum) is a surgical procedure that consists of a thorough examination of a corpse by dissection to determine the cause, mode, and manner of death or to evaluate any di ...
, it was surprising that her transplanted kidneys did not show any signs of rejection and appeared normal.
Later, the notion of using nonhuman primates as kidney donors was expanded by a number of surgeons, particularly by
Tom Starzl
Thomas Earl Starzl (March 11, 1926 – March 4, 2017) was an American physician, researcher, and expert on organ transplants. He performed the first human liver transplants, and has often been referred to as "the father of modern transplantatio ...
.
In 1963,
James Hardy, who had carried out the first human lung
allotransplant
Allotransplant (''allo-'' meaning "other" in Greek) is the transplantation of cells, tissues, or organs to a recipient from a genetically non-identical donor of the same species. The transplant is called an allograft, allogeneic transplant, o ...
, visited Reemtsma and was impressed by the outcome of the chimpanzee kidney transplantations.
Hardy went on to transplant a chimpanzee heart into a human, however, they survived only a few hours.
In 1964, at the American Surgical Association meeting in
Hot Springs, Virginia
Hot Springs is a census-designated place (CDP) in Bath County, Virginia, United States. The population as of the 2010 Census was 738. It is located about southwest of Warm Springs on U.S. Route 220.
Hot Springs has several historic resorts, fo ...
, where he presented Tulane's experience of early xenotransplants, including the one patient surviving nine months, he was met with mixed emotions. However, his work gained him a promotion to full professor in 1966.
He remained sceptical of the persistent opposition to innovation.
First artificial heart
Between 1966 and 1971, Reemtsma assembled the team that eventually developed the first artificial heart. He was chairman of the Department of Surgery at the
University of Utah
The University of Utah (U of U, UofU, or simply The U) is a public research university in Salt Lake City, Utah. It is the flagship institution of the Utah System of Higher Education. The university was established in 1850 as the University of De ...
at the time, a position appointed to him in 1966. He recruited
Willem Kolff
Willem Johan "Pim" Kolff (February 14, 1911 – February 11, 2009) was a pioneer of hemodialysis, artificial heart, as well as in the entire field of artificial organs. Willem was a member of the Kolff family, an old Dutch patrician fam ...
,
the surgeon who, as a young doctor in the Nazi-occupied Netherlands during the
Second World War
World War II or the Second World War, often abbreviated as WWII or WW2, was a world war that lasted from 1939 to 1945. It involved the vast majority of the world's countries—including all of the great powers—forming two opposin ...
, invented the first dialysis machine using
sausage casing
Sausage casing, also known as sausage skin or simply casing, is the material that encloses the filling of a sausage. Natural casings are made from animal intestines or skin; artificial casings, introduced in the early 20th century, are made of col ...
s and an automobile water pump part.
Both were key players in the assembling of the ideal team of surgeons and engineers that eventually implanted the first artificial heart.
New York-Presbyterian Hospital transplant services
Reemtsma then moved again to become chairman of the Department of Surgery at
NewYork–Presbyterian Hospital The NewYork-Presbyterian Hospital is a nonprofit academic medical center in New York City affiliated with two Ivy League medical schools, Cornell University and Columbia University. The hospital comprises seven distinct campuses located in the New Y ...
and the Columbia University College of Physicians and Surgeons from 1971 to 1994. He had an overarching vision that surgery should be transformed from a predominantly destructive discipline of incision, excision, and amputation to a creative discipline of reconstruction, repair, replacement, and renewal.
In 1971, whilst at Columbia-Presbyterian Medical Center (the Hospital was renamed in 1998), Reemtsma recruited surgeon
Mark A. Hardy, who in turn established the programme for dialysis and kidney transplantation and started the shared clinical care between renal transplant surgeons and
renal physicians, at a time when the two faculties were considered separate. Reemtsma and surgical colleague
Eric Rose
Eric A. Rose is an American cardiothoracic surgeon, scientist, entrepreneur and professor and Chairman of the Department of Population Health Science & Policy, and Associate Director for Clinical Outcomes at Mount Sinai Heart. He is best known ...
further developed the New York-Presbyterian Hospital transplant services on the principles of a multidisciplinary cooperation between surgeons, nephrologists, immunologists and others.
Subsequently, the center established research in
immunosuppressant therapy and
minimally invasive surgical procedures.
In addition, Reemtsma was the first to demonstrate that a mechanical circulatory assist device, the
intra-aortic balloon pump
The intra-aortic balloon pump (IABP) is a mechanical device that increases myocardial oxygen perfusion and indirectly increases cardiac output through afterload reduction. It consists of a cylindrical polyurethane balloon that sits in the aorta ...
, could function as a mechanical bridge to heart transplantation.
At a time when heart transplants were controversial and were only being performed by
Norman Shumway
Norman Edward Shumway (February 9, 1923 – February 10, 2006) was a pioneer of heart surgery at Stanford University. He was the 67th president of the American Association for Thoracic Surgery and the first to perform an adult human to hum ...
at
Stanford University
Stanford University, officially Leland Stanford Junior University, is a private research university in Stanford, California. The campus occupies , among the largest in the United States, and enrolls over 17,000 students. Stanford is consider ...
, and
Richard Lower in
Virginia
Virginia, officially the Commonwealth of Virginia, is a state in the Mid-Atlantic and Southeastern regions of the United States, between the Atlantic Coast and the Appalachian Mountains. The geography and climate of the Commonwealth ar ...
, Reemtsma was committed and succeeded in strengthening Columbia's cardiac residency training programme.
Pancreatic islet transplantation
Reemtsma spent many years investigating the possibility of non-human
islet cell transplantation
Islet transplantation is the transplantation of isolated islets from a donor pancreas into another person. It is an experimental treatment for type 1 diabetes mellitus. Once transplanted, the islets begin to produce insulin, actively regulating th ...
for
diabetes mellitus
Diabetes, also known as diabetes mellitus, is a group of metabolic disorders characterized by a high blood sugar level ( hyperglycemia) over a prolonged period of time. Symptoms often include frequent urination, increased thirst and increased ap ...
and in turn influenced Eric Rose who in turn influenced Mark Hardy, the result being a Pancreatic Islet Transplantation Programme.
Personal and family
Reemtsma met his first wife Ann Pierce at school and they later married while in medical school. They had two sons, Dirk and Lance. Following a divorce he married Judy Towers, a New York–based medical TV producer, in 1972 and they remained married until his death.
His interests outside of surgery included writing a
play
Play most commonly refers to:
* Play (activity), an activity done for enjoyment
* Play (theatre), a work of drama
Play may refer also to:
Computers and technology
* Google Play, a digital content service
* Play Framework, a Java framework
* Pla ...
involving the artist Jan Vermeer and the scientist
Antonie van Leeuwenhoek
Antonie Philips van Leeuwenhoek ( ; ; 24 October 1632 – 26 August 1723) was a Dutch microbiologist and microscopist in the Golden Age of Dutch science and technology. A largely self-taught man in science, he is commonly known as " the ...
.
Reemtsma frequently reiterated the story about how owing to his service in Korea, and his behavior and build, he was the model for "
Hawkeye Pierce
This is a list of characters from the ''M*A*S*H'' franchise, covering the various fictional characters appearing in the novel '' MASH: A Novel About Three Army Doctors'' and its sequels, the 1970 film adaptation of the novel, and the televisio ...
" in Richard Hooker's novel ''
MASH''.
Honours and awards
Reemtsma was president of the Society of Clinical Surgery in 1976, president of the American Association for Thoracic Surgery (AATS) from 1990 to 1991, and the first vice president of the
American Surgical Association The American Surgical Association is the oldest surgical organization in the United States.
History
It was founded in 1880. Their publication, ''Annals of Surgery'', was started in 1885.
A collection of the association's papers are held at the Nat ...
in 1992.
He received the
International Society for Heart and Lung Transplantation (ISHLT) Lifetime Achievement Award in 1999.
Death and legacy
Reemtsma died from
liver cancer
Liver cancer (also known as hepatic cancer, primary hepatic cancer, or primary hepatic malignancy) is cancer that starts in the liver. Liver cancer can be primary (starts in liver) or secondary (meaning cancer which has spread from elsewhere to th ...
on 23 June 2000 at his home in
Manhattan
Manhattan (), known regionally as the City, is the most densely populated and geographically smallest of the five boroughs of New York City. The borough is also coextensive with New York County, one of the original counties of the U.S. state ...
. He was 74.
A student society exists in his name at Columbia University and the Keith Reemtsma Surgical Resident of the Year Award is given by
Penn Medicine.
Selected publications
Articles
*
*
*
*
*
*
Book chapters
"Xenotransplantation — A Brief History of Clinical Experiences: 1900–1965" in D.K.C. Cooper, Ejvind Kemp, Keith Reemtsma, D.J.G. White (Eds.) (1991) ''Xenotransplantation: The Transplantation of Organs and Tissues Between Species''. Springer. pp. 9–22. ,
References
{{DEFAULTSORT:Reemtsma, Keith
1925 births
2000 deaths
American transplant surgeons
People from Madera, California
Columbia University faculty
American Presbyterians
Perelman School of Medicine at the University of Pennsylvania alumni
United States Navy personnel of the Korean War
United States Navy Medical Corps officers
Deaths from liver cancer
University of Utah School of Medicine faculty
Tulane University faculty
Xenotransplantation
Idaho State University alumni
History of surgery
History of transplant surgery
1964 in medicine
20th-century surgeons
Military personnel from California