In their own words:
It’s been, this deep privilege to be with the organization, the ASTS, for so long, and to have been a part in its formation and its propagation over the years. It’s been an amazing journey.
J. Wesley Alexander, MD received his medical degree from the University of Texas Medical Branch in Galveston. Following medical school, he trained in general surgery at the University of Cincinnati College of Medicine where he developed a number of programs including those related to pediatric burn care, bariatric surgery, and organ transplantation. Dr. Alexander performed the first kidney and the first kidney/pancreas in Cincinnati in the late 1960’s. A charter member, he served as the 15th President of the ASTS (1988-89), and during his presidency awards were expanded, training fellowships were better defined, and efforts to engage government agencies were successfully undertaken.
Wes Alexander: I’m Wes Alexander, and I really started into transplantation surgery when I was a youngster, six years old. I had a hernia operation, and my mother brought in a book and read about white blood cells. I kept that interest up all during residency, and when Dave Hume did his first kidney transplant, I was listening very carefully, and that stimulated the interest, along with the work that I had with Dr. Altamira, working on surgical infection.
Thomas Peters: You started the transplant program in Cincinnati. Tell us a little about how you started the transplant program.
Wes Alexander: Well, when I left for the army and a fellowship, I had already talked to Dr. Altamira who is Chairman of the Department [at that time], and we had agreed that I would come back and run the transplant program.
Thomas Peters: And when was that, and what were your transplant organs and volumes like?
Wes Alexander: When I started the transplantation in Cincinnati, it was in 1967 after I’d finished a fellowship with Dr. Robert Good, who is one of the famed immunologists, and through him, I learned an awful lot. The volume was fairly small at that time. The first transplant was done December 11, 1967, and it was not until the following April before we did the first cadaveric transplant, and I was the only person there to run the OPO and the transplant program, and a few other things, for the first four years. So you can imagine, during that time, we only had about eight or ten transplants a year, about one a month or so, the first year or two.
Thomas Peters: You were early in the multi organ experience. Can you tell us a little bit about extra-renal transplantation at Cincinnati?
Wes Alexander: Extra-renal transplantation started in Cincinnati and 1970; I believe it was, when they did the first combined kidney-pancreas transplant. Unfortunately, that wasn’t successful. That program went a little under cover for a few years. Then – did the first liver transplant at the University Hospital. I can’t remember exactly the year, but it was fairly early during the overall liver experience, certainly after the introduction of cyclosporine when this started; so, it was the mid-1980s.
Thomas Peters: The ASTS has played a role in your life. Can you tell us about the ASTS and its role in your life?
Wes Alexander: The ASTS is – it played a very important part of – role in my life. I was at the early meetings with the ASTS was started, and of course, as one of the founding members, and I was active in the organization ever since its beginning. I guess that my experience on the surgery study section at the NIH, and during that early period of time, sort of set the foundation for knowing a lot of people who worked in the ASTS, particularly people like Oscar Salvatierra. It was a fairly small group to begin with, and we learn to an awful lot from each other and had a high degree of camaraderie. So, it’s been the sort of my second home for a long time.
Thomas Peters: How do you think the ASTS advanced the science of transplantation?
Wes Alexander: How do I think the ASTS advanced the science of transplantation? That’s a ….. a good question, I guess, but I think that it’s fairly self-evident that, without the ASTS, you wouldn’t have been much advance in transplantation. People gathered together to exchange ideas, to exchange experiences, to think of new ways to treat patients, and I think that was really the…that set transplantation free.
Thomas Peters: Could you reflect on how your development of a transplantation service affected the University of Cincinnati College of Medicine and in Cincinnati General Hospital. I think that would be of interest, because I think other senior surgeons have had similar experiences. So, how did your transplantation service affect your medical school and university?
Wes Alexander: How did our transplantation service affect the university? Well, I think that it brought a lot of things to the university, because at that time, we had a lot of NIH grants, a lot of research going on. We had a fairly good training program. We have a lot of patients who became the longest-living patients with “disease X,” you know, that had cataract transplant, and so far – So, mostly because of the effects of other people working with me, you know, Betty Ogles and Roy First and people like that. It became a program, which was at least respected, I think, and the – I think the university probably benefited from it. You’d have to ask the university about that.
Thomas Peters: [laughter]
Wes Alexander: I don’t know. It’s a difficult thing for me to say. But I think that it was certainly a positive influence, not only on the university, but within the city as well.
Thomas Peters: You were fortunate to have a colleague named Israel Penn. Can you tell us about Sol’s move to the University of Cincinnati and what he did and how you interacted with him?
Wes Alexander: Israel Penn was recruited by Dr. Fisher to run the VA hospital. We had some difficulties in the management of the surgical services there, and Dr. Penn finally graciously decided to come. And he brought with him the considerable experience in liver transplantation, and working with Tom Starzl, I guess, nearly since the beginning. And he had also developed the registry for looking at cancer patients, their patients with transplants that had developed cancer over the years. So, he brought with them was registry, which I think has continued to grow, and after his death in 1999, it is still function extremely well, and it has a lot of consults, which are always free to the individuals above what the experience has been. The amazing thing about that was that Sol did this all by himself. He would talk to people around the world, and he would get them to send in forms and follow-up study and put them in the computer himself, and it was a one-man show. He was really phenomenal.
Thomas Peters: You’ve been an operating surgeon all of your life. Can you tell us of any amusing moments in the operating room during a transplant operation?
Wes Alexander: The amusing moments during a transplant operation? Yes. I can think of at least one. We had taken the kidneys from a cadaveric donor in the early evening, about nine or ten o’clock, and got one of the recipients in to do a transplant on, and had called around the country to see if we could place the other kidney, and we had by about 1:00 in the morning. But there were no planes flying at the time. So we were going to keep it ‘till the next morning, then send it out. As we did the transplant on the intended recipient that we were working on, at that time, we did all of the transplants under epidural anesthesia because the incidence of pneumonia was a little bit too high for us to accept it otherwise. And the anesthesiologist (mispronounced) was sort of asleep at the upper end of the table, and as we got the kidney in, and then sewed in the artery and the vein, the patient woke up, and he wretched. Like, he was violently throwing up, and the kidney, like a squeezed watermelon seed, pumped over into the corner of the room. [laughter] Of course, that elicited a lot of concern with the arterial and venous bleeding there. But once we got that stopped, we scratched our heads and said, “Well, let’s use the other kidney.” So, we used the other kidney, same spot, this time with the patient a little more sedated, and the kidney worked fine.
Thomas Peters: You were a president of the ASTS. Can you recall some of the issues that you dealt with during your presidency?
Wes Alexander: Issues that we dealt with during the pregnancy … presidency, were ---
Thomas Peters: Let’s start that sentence again.
Wes Alexander: Okay. [laughter]
Thomas Peters: Yeah. And we’re allowed to do that.
Wes Alexander: I wasn’t pregnant …
Thomas Peters: [laughter] Right. But it sounds like that kidney that flew across the room was.
Wes Alexander: I look like it. [laughter] Yeah. That was a “violent hyper-acute rejection,” we’d call it.
Thomas Peters: [laughter] So, issues during your … your presidency.
Wes Alexander: I’d say there were issues during the presidency of the ASTS which focused a lot on training programs and how to best effect them. To monitor the people that went through the training programs, to monitor the programs themselves, how to deal with accreditation and, being sure that we had individuals adequately trained for whatever they were going into. A lot of the centers were being set up for multi-organ transplant programs at that time, and we had to set the criteria and the numbers that were there. We also dealt with trying to increase research for transplantation studies at the particular time too. That was an issue because of the decreased funding from the National Institute – I think every president sort of had to deal with that problem. And we were also dealing with issues related to payment for, adequate payment for, services in the living-donor programs, as well as cadaver programs, and the recruitment of cadaveric donors, the whole donor issue, how to handle it, was very much on the forefront at about the time.
Thomas Peters: When you started in transplantation, now 40 years ago, could you have imagined how this surgical endeavor would have grown?
Wes Alexander: Could I imagine how the surgical endeavor of transplantation could have grown, 40 years ago? I’d have to say, yes. In fact, my presidential address was focused a lot on how it would grow during the next 15 years, and some predictions came true, and others didn’t come true. I thought by now, we would have tolerance that we don’t have yet, although we’re pretty close, and there’s some evidence of tolerance in some individuals. So, I guess it’s partly true. But, no. I’ve I felt then, and I feel now, that transplantation is revolutionizing medicine, and that the other things that are revolutionizing, like genetics and gene therapy and things like that, will interplay with them to give us further insight into the mechanisms and the possibility of doing xeno-transplants, or transplanting whatever we want to.
Thomas Peters: Wes, is there anything that you would like to add to the conversation?
Wes Alexander: Anything that I would like to add to the conversation? Yes. I guess so. I would like to just say that it’s been, you know, this deep privilege to be with the organization, the ASTS, for so long, and to have been a part in its formation and its propagation over the years. It’s been an amazing journey.
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