"The first remembrance that I have of transplantation in my life was sitting with my parents in the 1950’s listening to the radio and I was a high school student and I heard that Dr. Joseph Murray had done a kidney transplant on twins in Boston and I just thought that was some fantastic science fiction, that somehow that was the epitome of success and technology. And I don’t think I then said I want to be like Joseph Murray, that would have been foolish, but it somehow was imbedded."
Sylvester Sterioff, MD, is Professor of Surgery at the Mayo Clinic in Rochester, Minnesota where he has served for nearly four decades. Following his medical school training at Washington University in St. Louis, Dr. Sterioff trained in general surgery at the University Hospitals in Cleveland, Ohio. Settling at the Mayo Clinic, he developed interests in organ donation and transplantation, living kidney donation, and long-term transplant outcomes while continuing to practice general and oncologic surgery as he directed development of transplantation at the Mayo Clinic.
Sylvester Sterioff: I’m Sylvester Sterioff. I’m a transplant surgeon at the Mayo Clinic and a general surgeon as well.
And I’ve thoroughly enjoyed my time in this field and with the American Society of Transplant Surgeons.
Goran Klintmalm: Thank you. And what was it that led you into transplant surgery.
Sylvester Sterioff: The first remembrance that I have of transplantation in my life was sitting with my parents in the 1950’s listening to the radio and I was a high school student and I heard that Dr. Joseph Murray had done a kidney transplant on twins in Boston and I just thought that was some fantastic science fiction, that somehow that was the epitome of success and technology. And I don’t think I then said I want to be like Joseph Murray, that would have been foolish, but it somehow was imbedded. So that eventually when I went through medical school and surgical training, I had a professor of surgery who said think about your career in 25 years, what do you want to do then, not what do you want to do the day you finish your residency, because everybody had their face to the windshield at that point. And I thought, gee, that’s a wonderful thought, but I don’t know if I can predict. But transplantation in the 1960’s when I finished my residency was just coming into its recognition. Dr. Starzl was known, the first cadaver kidneys had been done and so I thought that was something I would like to aspire to.
Goran Klintmalm: And from that, how did you actually get in, how did you get yourself involved in that?
Sylvester Sterioff: When I was a surgical resident I took an interest in immunological responses and the highest technology we had was a mixed lymphocyte culture and I did mixed lymphocyte cultures on burn patients to see what their response was, what their stimulation was, etc., and so I had this kind of interest that this might be an expanding field, an interesting field and then there was the Vietnam War and although I was not assigned to Vietnam I had to go into the Armed Forces and I went to a remote base in Labradore in the U.S. Air Force. And here I was a thoroughly trained, general surgeon and just bored silly. And I just didn’t know what in the world I was going to do for two years other than fish for salmon and trout. So the gynecologist who was assigned there was going bald and he convinced me that I should do some hair transplants on him. So my first transplants were hair transplants for him. I made him anemic in the process and had to give him iron, but at that point I thought, you know, maybe I should pursue this. So I wrote to my professor who had given me this advice to do something futuristic and he gave me advice to go to speak with Tony Monaco in Boston and Mel Williams in Richmond at the time. I spoke with both of those people about further training and because Mel Williams didn’t have a fellowship he offered me a junior faculty position. I went to Johns Hopkins a year after he started the program there.
Goran Klintmalm: And by the way, what happened with the hair you transplanted? Did it stay?
Sylvester Sterioff: The gynecologist remained a good friend of mine. It was a little pebbly on the top, but he was very proud of the hairs that he had on his head and we remained friends after that and vacationed together.
Goran Klintmalm: Being a transplant surgeon at the time, that meant what to you as a surgeon in the general surgery department?
Sylvester Sterioff: The life of a transplant surgeon at that time wasn’t 100% in transplantation. You had a day job which was usually general surgery and vascular access and then you had a night and weekend job that was kidney transplantation. So that a wide range of general surgery was expected, you continued with your personal life as best you could, but it was a very trying time. Mel Williams was my mentor at Hopkins and he pretty much took care of the Johns Hopkins Hospital whereas I was assigned to Baltimore City Hospital which also had a transplant program. If I can continue with another story, the conditions at Baltimore City Hospital even in the early 1970’s weren’t so, wasn’t so modern. It was a difficult place. And although there were many attributes that had an intensive care unit which was pioneering at that time, but we did some kidney transplants and some of these patients developed aspergillosis, serious lung infections and we could not figure out why they should do that, but we had a bacteriologist who was very compulsive and was able to grow aspergilla from the air vents coming into the one room that we had for the post kidney transplant patient and then we started looking around and found that the pigeons were defecating into the air intake part. Well, this is kind of embarrassing to try to publish this kind of thing or even present it at the ASTS, but we felt that we had shown that something about hospital design was important so I think we published it in a Journal of Hospital Engineering, but we did get it into the literature.
Goran Klintmalm: Being a transplant surgeon those days, they were very much highs and lows and sometimes the high is to come realize the concept, sometimes it’s getting away with a case, anything like that that stands out?
Sylvester Sterioff: Well, the biggest low, I think about transplantation in the 1970’s is that there was a plateau of results that didn’t seem to improve year after year. We could perhaps do 35 to 50% success, the rest of the patients failed, they usually didn’t do well if they went back on dialysis and it was a depressing time and many of my contemporaries in transplantation got out of the field because there was no improvement and it didn’t look like there was anything on the horizon until some of the antilymphocyte globulin came along and that Roy Cohn developed some new immunosuppressive therapies with Cyclosporine and Dr. Starzl showed that this was successful in other organs. So it was a low time.
Goran Klintmalm: What was the high time?
Sylvester Sterioff: The high times were seeing patients improve and seeing them go from a really miserable life on dialysis to productive and active life. I think that was the high times and also being able to interact with my colleagues in this difficult field with the residents and teaching them something about care of difficult patients. So those were the high times.
And overall, overall, the high time was being able to see success in kidney transplantation, liver, pancreas, improve from 35% to 95% in one surgical lifetime. I thought that was a real kick.
Goran Klintmalm: Always the transplantation engulfs and enriches all of us, all our lives we have been in sort of the middle of this, how has it impacted your life?
Sylvester Sterioff: It was an all consuming, transplantation was an all consuming field. You were on call all the time. I’ve told my wife that when I’m in my casket I want my beeper on and I want somebody to page me to be sure that I’m dead. Nonetheless, it was an all consuming life and it took its toll on our personal lives as well. There was no doubt that it took us away from family, it was hard. But it seemed to be worthwhile, it was worthwhile in every aspect of the care of the patient, the interaction with donor families, that was also an emotional time and it was a time when we were really put to the test as could we convince someone about doing organ donation. I might add that at that time in the ‘70s, we really didn’t have the infrastructure that we have now. I’m happy we have the infrastructure, I think that the support that we have particularly from transplant coordinators has been extremely helpful and they are better at it than we are.
Goran Klintmalm: The ASTS in all this, and you mentioned ASTS before, how do you, I mean, you saw ASTS being formed and begin to get legs and take off, how do you see ASTS, your part of ASTS and ASTS part of your life, what has it been to you?
Sylvester Sterioff: The ASTS was a high water mark each year. You aspired to have a paper on the program and oftentimes you were disappointed because at that time maybe 35 papers were on the program that you had to have very good case and a good argument to have your paper on the program. But it was also a time when you got to see your colleagues and talk about things. We didn’t have the word quality control at that point, this was quality control. This was talking to someone about the issues that were at hand or someone that you had just sent a kidney to and you wanted to be sure that the kidney was in good shape when he, there weren’t very many women surgeons at the time, was happy with that kidney.
Goran Klintmalm: That’s so important. Is there anything else you’d like to add? An anecdote?
Sylvester Sterioff: Well, I know that one of the questions has been what funny thing happened in the operating room and I don’t know that it was funny, but it was a memorable event in the operating room and I was assisting one of the wonderful Hopkins residents who went on to have a distinguished career as a general surgical professor at Johns Hopkins. When we were doing a kidney transplant on a man who was known hepatitis B positive and at that time, we didn’t select many patients who were hepatitis B positive, but was otherwise in good health. During the case he let out a swear word and said, “You stuck me with the needle.” And he was very angry and upset and he stripped his glove off and there was no blood in his glove, there was no mark on his finger and he rescrubbed and came back in and we continued the case. And I let him do some, of course, and I did some and at the end of the case I took my glove off and I had blood inside my glove and six weeks later I had hepatitis B. So, it was an expected thing that you could get hepatitis, but I was young at the time, I recovered fairly quickly and in a few months back to work. So that was a memorable OR experience.
[END OF AUDIO]