Keith Reemtsma

Keith Reemtsma
File:Keith Reemtsma.jpg
Born	5 December 1925 Madera, California
Died	23 June 2000
Nationality	American
Occupation	Surgeon
Medical career
Sub-specialties	Xenotransplantation

Keith Reemtsma (5 December 1925 - 23 June 2000) was a pioneering transplant surgeon, best known for transplanting a chimpanzee kidney into a woman in 1963. With only primitive immunosuppressants and no long-term dialysis, she survived nine months, long enough to return to work.

He was brought up on a Navajo-Indian reservation in Arizona, eventually moving to Utah and then graduating from Idaho State College in Pocatello in 1945. In the 1960s he was professor of surgery at Tulane University, Louisiana and he later became chairman of the Department of Surgery at the University of Utah.

He also developed the intra-aortic balloon pump to bridge the time to heart transplant, and performed early research on pancreatic islet cell transplantation for diabetes mellitus. In 1971, he was appointed chairman of the Department of Surgery of the Columbia University College of Physicians and Surgeons, where he was involved in developing a multidisciplinary approach to transplant services, as well as advocating surgical repair and reconstruction as an alternative to radical excision.

He died at the age of 74 in 2000.

Early life

Keith Reemtsma was born in Madera, California on 5 December 1925, to the Presbyterian minister and missionary Reverend Henry and Pauline Reemtsma. He had one older sister, Carol, and from 1938 was raised on a Navajo-Indian reservation in Arizona when he attended a one-room school house which taught only to eighth grade.

As he progressed in his education, he moved from schools in Oklahoma to a Presbyterian boarding school in Mount Pleasant, Utah, where he met his first wife to be, Ann Pierce. He attended Idaho State College as part of the United States Navy V-12 programme, where the federal government funded studies to participating colleges. Here, wearing Navy uniform was mandatory and he would have had to participate in strenuous exercise. He completed his pre-medical studies and graduated in 1945.

Reemtsma subsequently attended the University of Pennsylvania School of Medicine, graduating in 1949, and was inducted into the Phi Chi Medical Fraternity.

Early surgical training

Reemtsma trained under peadiatric surgeon C. Everett Koop who encouraged him to go to Columbia for his surgical residency, under paediatric thoracic surgeon, George Humphreys.

Following his internship, his early surgical career was interrupted by the Korean War, where he served in the Marines with surgeon Frank Spencer as part of US Navy Surgical Team, Far East Command.

Returning to New York in 1954, he then completed his residency at Columbia in 1957, following which he moved south to Tulane University. Here, under Oscar Creech, Reemtsma was recruited to help build a cardiac surgery service. However, he turned his attention toward renal transplantation and cross-species chimpanzee-to-human kidney transplants instead.

Surgical career

Xenotransplantatioin

Prior to the 1960s, long term kidney dialysis was not available, human donors were scarce and immunosuppressants were primitive. Cyclosporine was not available for use in people until the late 1970s. During the early 1960s, whilst professor of surgery at Tulane University, Louisiana, Reemtsma performed a series of chimpanzee-to-human kidney transplants. He posited that nonhuman primate kidneys might function in human recipients and therefore be a successful treatment for renal failure, the alternative being death. Retired from space-flight or the circus, bad-tempered or no longer wanted, these chimpanzee's kidneys were transplanted into thirteen people, of which most survived between just over one week to two months, failure being due to organ rejection or post-operative infection. One female school teacher, who had the procedure performed in 1963, lived to return back to work and survived nine months. Her death from cardiac arrest was found to be due to a derangement of electrolytes possibly due to the excessive urination observed following chimpanzee kidney transplantation (frequently greater than 20 liters per day), as the chimpanzee kidneys probably did not work precisely likely human kidneys. At autopsy, it was surprising that her transplanted kidneys did not show any signs of rejection and appeared normal.

Later, the notion of using nonhuman primates as kidney donors was expanded by a number of surgeons, particularly by Tom Starzl. In 1963, James Hardy, who had carried out the first human lung allotransplant, visited Reemtsma and was impressed by the outcome of the chimpanzee kidney transplantations. Hardy went on to transplant a chimpanzee heart into a human, however, they survived only a few hours.

In 1964, at the American Surgical Association meeting in Hot Springs, Virginia, where he presented Tulane’s experience of early xenotransplants, including the one patient surviving nine months, he was met with mixed opinion. However, his work gained him a promotion to full professor in 1966.

First artificial heart

Between 1966 and 1971, Reemtsma assembled the team that eventually developed the first artificial heart. He was chairman of the Department of Surgery at the University of Utah at the time, a position appointed to him in 1966. He recruited Willem Kolff, the surgeon who, as a young doctor in the Nazi-occupied Netherlands during the Second World War, invented the first dialysis machine using sausage casings and an automobile water pump part. Both were key players in the assembling of the ideal team of surgeons and engineers that eventually implanted the first artificial heart.

NewYork-Presbyterian Hospital transplant services

Reemtsma then moved again to become chairman of the Department of Surgery of the Columbia University College of Physicians and Surgeons from 1971 to 1994. He had an overarching vision that surgery should be transformed from a predominantly destructive discipline of incision, excision, and amputation to a creative discipline of reconstruction, repair, replacement, and renewal.

In 1971, whilst at Columbia-Presbyterian Medical Center, Reemtsma recruited surgeon Mark A. Hardy, who in turn established the programme for dialysis and kidney transplantation and started the shared clinical care between renal transplant surgeons and renal physicians, at a time when the two faculties were considered separate. Reemtsma and surgical colleague Eric Rose further developed the NewYork-Presbyterian Hospital transplant services on the principles of a multidisciplinary cooperation between surgeons, nephrologists, immunologists and others. Subsequently, the center established research in immunosuppressant therapy and minimally invasive surgical procedures.

In addition, Reemtsma was the first to demonstrate that a mechanical circulatory assist device, the intra-aortic balloon pump, could function as a mechanical bridge to heart transplantation. At a time when heart transplants were controversial and were only being performed by Norman Shumway at Stanford University, and Richard Lower in Virginia, Reemtsma was committed and succeeded in strengthening Columbia's cardiac residency training programme.

Pancreatic Islet Transplantation

Reemtsma spent many years investigating the possibility of non-human islet cell transplantation for diabetes mellitus and in turn influenced Eric Rose who in turn influenced Mark Hardy, the result being a Pancreatic Islet Transplantation Programme.

Personal and family

Reemtsma met his first wife Ann Pierce at school and they later married while in medical school. They had two sons, Dirk and Lance. Following a divorce shortly after Dirk started college, he married Judy Towers, a New York–based medical TV producer in 1972 and they remained married until his death.

His interests outside of surgery included writing a play involving the artist Jan Vermeer and the scientist Antonie van Leeuwenhoek.

Reemtsma himself, frequently reiterated the mythical story about how owing to his service in Korea, and his behaviour and build, was the model for ‘‘Hawkeye Pierce’’ in Richard Hooker’s novel M*A*S*H.

Honours and Awards

Reemtsma was president of the Society of Clinical Surgery in 1976, president of the American Association for Thoracic Surgery (AATS) from 1990 to 1991, and the first vice president of the American Surgical Association in 1992.

He received the International Society for Heart and Lung Transplantation (ISHLT) Lifetime Achievement Award in 1999.

Death and legacy

Reemstma died from liver cancer on 23 June 2000 at his home in Manhattan. He was 74.

A student society exists in his name at Columbia University and the Keith Reemtsma Surgical Resident of the Year Award is given by Penn Medicine.

Selected publications

• "Islet cell transplantation", Annals of Surgery, co-authored with  N Giraldo, D A Depp, and  E J Eichwald, PMID 4877590, September 1968, p.436-446.
• “Alternatives in Pancreatic Islet Transplantation: Tissue Culture Studies”, American Diabetes Association, co-authored with Collin J Weber, F Xavier Pi-Sunyer, Roger L Lerner and Mark A, Hardy, doi:10.2337/diab.29.1.S45, February 1980, p.45-51.
• "Supporting Future Surgical Innovation", Annals of Surgery, co-authored with J E Sisk, R R Arons, P M Boozang, G K Berland, C M Evans, and C R Smith, doi:10.1097/00000658-199310000-00007, October 1993, p.465-475.
• "Xenotransplantation: A Historical Perspective", ILAR journal / National Research Council, Institute of Laboratory Animal Resources, doi:10.1093/ilar.37.1.9, February 1995, p.9-12.
• "Address by the Honorary Founding President of the Xenotransplantation Society The Eye of an Eagle: xenobiology and the quest for bioadvantage",  Xenotransplantation, doi:10.1034/j.1399-3089.2000.00045.x, June 2000, p.80-82.

Book chapter

• "Xenotransplantation — A Brief History of Clinical Experiences: 1900–1965", from book Xenotransplantation: The Transplantation of Organs and Tissues Between Species, January 1991, doi:10.1007/978-3-642-97323-9, ISBN 978-3-642-97325-3, p.9-22.