Advanced clinical care for transplant patients: Intravenous pulse dose methylprednisolone effectively reverses acute rejection of transplanted kidneys. Laid the foundation for kidney perfusion machine. First clinical study on living-unrelated kidney transplants based on HLA matching.

Institution:

SUNY Downstate Medical Center

Researchers:

Samuel Lee Kountz, MD, Professor and Chair of Surgery, SUNY Downstate Medical Center, 1972-1981.

Impact:

Kountz was a pioneering African-American renal transplant surgeon who developed new techniques to preserve organs and reduce organ rejection. He conducted a significant portion of his research prior to his appointment at SUNY Downstate Medical Center. However, while at Downstate, Kountz developed a world-class kidney transplant program that ensured his research would be translated into clinical care, and that access to high quality renal transplant care would be available to a diverse inner city population. The program Kountz developed at Downstate was immersed in clinical kidney transplantation, recovery, and perfusion preservation of deceased door kidneys, as well as animal laboratory research in organ preservation and transplantation.

Kountz was appointed chair of surgery at Downstate in 1972.  Prior to this, Kountz had served on the faculties of Stanford and the University of California-San Francisco, where he served as director of the renal transplantation service. In 1960, Kountz was a member of the team that performed the first successful kidney transplant on the West Coast. In 1962 he was awarded a fellowship to study in London; while there, with W.J. Dempster, Kountz discovered that cells of the host attacked and destroyed the small blood vessels of the transplanted kidney, thus causing the kidney to die from lack of blood supplied oxygen. At Stanford, Kountz and colleagues discovered that high doses of methylprednisolone delivered over carefully timed intervals could arrest and/or reverse the rejection of a transplant, a finding that provided the only effective remedy for many years. Prior to the development of Kountz’s technique of detecting and treating rejection, less than 5 percent of transplant patients survived for more than two years. At the University of California, Kountz collaborated with Folkert Beltzer to develop equipment and techniques for preserving kidneys by perfusion. The machine they developed allowed kidneys harvested for transplant to remain viable for up to 72 hours, thereby permitting kidneys to be safely transported for long distances and be shared on the basis of best available match.

At Downstate, Kountz chose Khalid M.H. Butt to lead Downstate’s transplant division and together they created a program noted for the intensity of its clinical activity, performing over 100 kidney transplants a year. Downstate achieved its landmark 1000th kidney transplant ahead of any other transplant center in the region. In 1978 Butt was appointed the first president of the fledgling New York Regional Transplant Program (later to be called the New York Organ Donor Network, and now LiveOn New York), the major organ recovery agency in the New York metropolitan area.

While Kountz’s time at Downstate was cut short (he was forced to retire after contracting a neurologic illness during a 1977 trip to Africa and tragically died in 1981 at the age of 51) he used his prominence and charisma to champion transplantation and to build at Downstate the busiest transplant program on the Eastern seaboard. At the time of Kountz’s appointment to Downstate – and to this day – Brooklyn had a high incidence of end-stage renal disease. Kountz and those who have followed in his footsteps at Downstate have ensured that residents of the borough and region benefit from the most-up-to date research in kidney transplantation.

Timeline:

1960s – 1980s.