The Hospital Clínic commemorates the 40th anniversary of the first pancreas transplant in Spain, led by Laureano Fernández-Cruz and Josep Maria Gil-Vernet. In 1983, a 32-year-old man, a diabetic since childhood, received a double kidney-pancreas graft. Despite its pioneering nature, the intervention was a success. The patient had a good quality of life, was able to start a family and returned to work. He died ten years later due to a myocardial infarction, unrelated to the transplant, recalls the doctor.
He went to study abroad when healthcare in Spain was very poor.
My generation made a revolution regarding the organization of hospitals. In the 1970s, many doctors left to train in specific fields and start specialized medicine. Some did not return, others we did because specific cities or hospitals needed to set up certain hospitalization areas. Public medicine today is based on that effort of my generation. Before going to a public hospital was laughable, now the best medicine is in public hospitals.
Did you see very different things in the US?
I saw a medical organization that gives meaning to our specialty, which is to diagnose, treat the sick and cure them. Here everything was a system with many unknowns regarding early diagnosis or treatments, which with few resources were not adequate. And the clinical control of these patients also left much to be desired.
Why did you decide to return?
I joined a type of medicine that I believed could be developed in our country. Because of the education I had, I was privileged, and my father always reminded me and my two brothers that we should give back to society the privilege of having had a good education and the possibility of training in relevant places. The three of us complied.
In those days, transplants must have seemed like magic.
In Spain, the Clínic was the first hospital to organize kidney transplants on a scheduled basis. It began in 1965 with some nephrologists, Antoni Queralbs and Jordi Alsina, who had trained in France. Queralbs put me in touch with Dr. Gil Vernet and we talked about the possibility of getting together, because one of the things that interested me at the University of California was a program on the prevention of kidney disease in diabetic patients through pancreas transplantation. They gave me the Fubright scholarship and I went there to participate in research in this field.
18 years between the first kidney transplant and the pancreas transplant.
The pancreas is a very delicate organ, prone to complications after transplantation. It becomes inflamed, thrombosis occurs... From an anatomical point of view, it is designed in such a way that it suffers when manipulated. That is why the transplant took a long time to consolidate. All the transplants in their beginnings had very poor results, and the pancreas one even more so.
Did they have them all with them? How did you feel when everything went well?
In the vast majority of transplant programs, the first operations have failed. Our first transplant lasted ten years! We rehabilitated a diabetic patient who had retinopathy, a very important ocular alteration, a neuropathy that caused disorders... And also some kidney failure. We completely rehabilitate it. So this first transplant worked very well and we started a journey.
What impact did they have?
We provoked a revolution in the world of transplantation in our country. We did the first extrarenal organ transplant and this encouraged colleagues. The following year, in Bellvitge, Dr. Carles Margarit and Eduard Jaurrieta began the liver transplant. And a colleague of mine, Dr. Josep Maria Caralps, did the first with success, in Sant Pau. On the other hand, we teach the importance of putting together the transplant organization, which today is the Ocatt (Organització Catalana de Trasplantament) and at the national level the ONT (National Transplant Organization). It was essential to organize a structure to manage donors. This was an extraordinary success. The enthusiasm we had at the Clínic we expanded to other hospitals. This changed the way hospitals collaborate. Before they all worked in their own way. And we doctors went from hospital subjects to citizens.
How have transplants changed in 40 years?
The surgical technique has been gradually refined. In Barcelona, in 1989, I organized the European Organ Transplant Meeting, where the American Transplant Society presented the first results of an immunosuppressant drug to reduce the risk of rejection, tacrolimus, which has revolutionized transplant medicine.
The next frontier?
What we need are more organs. Since organs are missing, we enter other fields such as the possibility of genetic manipulation. Animal studies have been carried out in China... The creation of artificial organs is another line of research. They are borders that are in a nebula. They are not defined. No further step is taken for ethical reasons.
Will the brain be transplanted?
We consider an organ donor when there is brain death. It is the central organ of the body, exerts a direct influence on all organs, apart from giving you the ability to be and feel. Existence is by the brain. The physical substrate of the soul are the neurons. Therefore, I do not see the future as talking about a brain transplant.
