Alexis Carrel

Transplantation of the kidney with implantation of the renal vessels in the aorta and vena cava

The transplantation of the kidney with implantation of the renal vessels in the aorta and vena cava consists of extirpating from an animal a kidney with its vessels, together with a patch of the aorta and vena cava; also of transplanting the kidney into the abdomen of another animal and suturing the edges of the patches to the edges of suitable openings made in the walls of the aorta and vena cava. By this patching method, the anastomoses are more safely performed than by the other methods of anastomosis. If the patch be large enough, occurrence of gangrene in the transplanted organ is practically impossible. With Guthrie, I used this method mainly on cats and obtained excellent results from the standpoint of restoration of the circulation. In dogs, on account of the shape of the abdomen, it is difficult to prevent the occurrence of congestion of the kidney. This occurs because of compression of the renal vein between the aorta and the kidney. It could be prevented by putting the new kidney exactly at the place of the extirpated one. This operation is not dangerous. Of seven animals operated on, six remained in good health. The seventh died of intestinal intussusception four days after the operation.

Chemical nature of some substances required for the growth of fibroblasts and epithelial cells.

Pure strains of fibroblasts or of epithelial cells increase in mass in an unlimited manner, when they are cultivated in plasma and embryonic tissue juice. For 14 years, colonies of a strain of fibroblasts have doubled in size every 48 hours in such a medium. Pavement and thyroid epithelium also have been found to manufacture unlimited amounts of protoplasm from the constituents of embryonic juice. Neither epithelial cells nor fibroblasts multiply in serum proteins, egg albumin, crystallized egg albumin, amino acids from embryonic juice, or artificial mxtures of amino acids for a longer time than in Tyrode solution. So far, embryonic juice is the only material which has been found to maintain epithelial cells and fibroblasts in a conditoti of true cultivation. Investigation of the chemical nature of the nutritive materials in the embryo juice has led to the conclusion that the nitrogenous substance utilized by the tissues is the protein itself. The amino acids and other ultra-filtrable and dialyzable constituents slightly stimulated the migration and multiplication of the cells, but failed to produce an increase in the mass of the tissues. Since the protein of the embryo juice is utilized by the cells, it seems evident that it must be hydrolyzed and some intermediate product absorbed. Complete digestion by trypsin and pepsin produced only toxic substances. However, some of the higher cleavage products formed by the partial hydrolysis of protein have been found to produce the same effect as the protein of the embryo juice, causing continuous multiplication of cells and increase in the mass of tissue for long periods of time. In fact, some preparations of these protein hydrolytic products have given a larger increase in the mass of the tissue than has ever been obtained by embryo juice.

Remote results of the replantation of the spleen

On February 24, 1908, the spleen of a large dog was extir pated, then replanted and the circulation reëstablished after an interruption of forty-four minutes. On June 21, 1909, the abdomen was reopened and the spleen found normal. The dog was in excellent health. On November 1, 1909, the animal died at the farm. The spleen was normal from a microscopical and macroscopical standpoint. The anastomoses of the vessels were almost invisible. This experiment shows that a spleen extirpated and replanted remains in normal condition for more than twenty months after the operation.

Temporary diversion from the left ventricle to the descending aorta

In the plastic operations on the thoracic aorta, it is necessary not to interrupt the circulation for a long time. Therefore, the blood must be diverted. I described already the central diversion of the blood by intubation of the aorta. I attempted also to established a communication between the left ventricle and the descending aorta, by means of a paraffined rubber tube or a vein preserved in cold storage. I succeeded twice to direct the blood directly from the heart into the descending aorta. The ascending aorta was then clamped, and the circulation reversed through the upper part of the descending aorta. The purpose of these experiments is to develop a technique permitting operations on the first part of the arch of the aorta.

Presentation of a dog ten months after double nephrectomy and replantation of one kidney

The animal presented to the Society underwent the extirpation and replantation of the left kidney and the extirpation of the right kidney ten months ago. He is to-day in excellent health. The result shows that the perfusion of the kidney with Lockes solution, the interruption of the renal circulation for fifty minutes and the disconnection of the renal nerves with the central nervous system do not produce any lesion of the kidney incompatible with its functions.

Remote result of the transplantation of a segment of popliteal artery from a man to a bitch

I have shown that a segment of carotid artery of a dog transplanted onto the aorta of a cat can act as artery for one year at least. In order to ascertain whether the same result is obtainable when the animals are zoologically more distinct than cat and dog, segments of human arteries have been transplanted in dogs. One of these animals was shown to the Society. Seven months and twelve days ago, the abdominal aorta of the bitch shown to the society was severed, and a short segment of human popliteal artery was sutured to its cut ends. This popliteal artery belonged to a young man whose thigh was amputated by Dr. Ellsworth Eliot for an osteosarcoma. The vessel had been preserved in Lockes solution and kept in cold storage during the twenty four days which elapsed between the amputation and the transplantation. After the transplantation, the bitch remained in excellent health and the pulse of the femoral arteries was normal. Five months and twelve days after the operation, an exploratory laparotomy was performed. The circulation of the aorta was found normal and the popliteal artery in about the same condition as at the time of the operation. Seven months and twelve days after the operation, the pulse of the femoral arteries is still normal. This experiment shows that an artery, transplanted under certain conditions from man to dog, can act as artery for seven months at least.

Reestablishment of function in transplanted kidneys

Both kidneys, the left suprarenal gland, their vessels, their nerves and ganglia, the corresponding segments of the aorta and vena cava, the peritoneum, the ureters and a part of the bladder were removed in one mass from a female cat and transplanted in another female cat whose normal kidneys had been extirpated. The circulation was reestablished through the new kidneys and the flap of bladder sutured to an opening in the bladder of the host. After this operation, the animal remained in excellent condition. She walked and played like a normal young cat. She was drinking milk and eating a great deal of raw meat. She grew very fat and enjoyed good health. She urinated abundantly—from about 60 c.c. to 255 c.c. per 24 hours. The density of the urine was very changeable, generally from 1.015 to 1.035. Urea was abundant owing to the large amount of meat digested by the animal, and amounted to from 2.7 grams to 5.1 grams per 100 c.c. During the first few days, the urine was a little bloody. The amount of albumin found was 0.50 gram and 0.25 gram for 1000 c.c. on two different occasions. It disappeared from the urine eight days after the operation. On the thirteenth day, albumin was found again, and increased progressively from traces to 1.5 grams and more per liter. Progressive enlargement of both kidneys was observed. Thirty days after the operation, the animal became suddenly ill, and died on the thirty first day. Macrocopical examization : enlargement of both kidneys due apparently to a compression of the renal veins by a large organized clot infiltrating the subperitoneal and perivenous connective tissue between the kidneys. Macrocopical examization: slight acute diffuse nephritis and dilation of the blood vessels diffuse nephritis and dilation of the blood vessels.

Extirpation of both kidneys from a cat and transplantation of both kidneys from another cat, with exhibition of specimens:

Both kidneys from a cat were extirpated and immediately replaced by both kidneys from another cat. After this operation the animal urinated abundantly. Urine collected during the first few days contained albumin. On the fourteenth day, the cat was operated on for hernia of the small intestine through the abdominal wound. The animal died from general peritonitis one day after this second operation. The anatomical specimen shows that the kidneys are a little enlarged. There is a slight hydronephrosis on the left side. Nevertheless, both organs appear to be in good condition.