In the 1960s Roy Calne, professor of surgery at Cambridge University, was gripped by the emerging new science of transplantation to help those with kidney and liver failure.
Calne, who has died aged 93, became Britain’s premier transplant surgeon and researcher, achieving a number of firsts, including the first liver transplant in Europe in 1968, the world’s first liver, heart and lung transplant in 1986 (with John Wallwork) and the world’s first successful “organ cluster” transplant (stomach, intestine, pancreas, liver and kidney) in 1994.
The game changer and his greatest achievement was his use of drugs, including cyclosporine, to suppress the immune system and prevent organ rejection. By 1977 cyclosporine had increased the chance of surviving a year after a kidney transplant to around 80%, paving the way for transplant medicine to become mainstream and a huge expansion in the number of transplant units worldwide.
Calne’s interest in transplants began in 1950 when, as a medical student, he was shocked to hear that a young patient on his ward who was the same age as himself would be dead in two weeks from kidney failure. He asked why they could not save the patient’s life with a new kidney. He had never seen a transplant operation, but he thought technically it would not be difficult to detach the kidney from his connecting vein, ureter and artery, and graft in a new one. His consultant batted the suggestion away as impossibly naive. With so little known about the immune system, donor organs were nearly always rejected.
In 1957, while studying for the fellowship exam at the Royal College of Surgeons, Calne took a job at Oxford University as an anatomy demonstrator. There he heard the biologist Peter Medawar talking about cutting-edge research on immunological tolerance.
Medawar had injected newborn mice with cells from a different mouse. The immune systems of the host mice were still developing and would tolerate the cells from the donor, so that if you later gave them a skin graft from the donor mouse, it would be accepted. Afterwards Calne asked if there was any practical application for transplant patients and Medawar replied: “Absolutely none.”
Undeterred, Calne, who in 1958 was a surgeon at the Royal Free hospital in London, was determined that it should be possible to transplant organs and used his spare time to experiment with kidney transplants in animals. Initially he used irradiation to prevent their immune system rejecting the donor organ, but it was too toxic, so he tried the drug 6-mercaptopurine, with limited success.
He kept in touch with Medawar, who helped him get a Harkness fellowship in 1960 at the Peter Bent Brigham hospital in Boston to study with Francis Moore and Joseph Murray, the leading transplant surgeons of the day. In 1954 Murray had successfully carried out the world’s first human kidney transplant – the donor and recipient were identical twins, which overcame the organ rejection problem.
While in the US, Calne continued to experiment with animals (a collie called Lollipop lived for six months following a kidney graft) and also met the scientists George Hitchings and Gertrude Elion from the Burroughs Wellcome laboratory, who had created the immunosuppressant drug azathioprine, which when used with steroid drugs gave good results. When Calne returned to London, he took a job at St Mary’s hospital, where 20 patients had died following unsuccessful kidney transplants. They had been given X-rays to induce immune suppression, but at Calne’s insistence future patients were treated with azathioprine.
In 1965 Calne became both professor of surgery at Cambridge and a consultant at Addenbrooke’s hospital, where he stayed for 33 years. He embarked on a renal transplant programme and set up a tissue typing laboratory and blood bank, operating on his first kidney transplant patient in 1966.
When a woman with a malignant growth on her liver was referred to Addenbrooke’s in 1968, he decided to offer her a transplant. His hospital colleagues opposed the operation as too risky, but Moore, his former mentor from the US, happened to be in Cambridge and supported him, assisting him at what was the first liver transplant in Europe.
Encouraged by this, Calne formed a partnership with the hepatologist Roger Williams from King’s College hospital in London, in which he performed the surgery and Williams took care of the patients. Initially they and the recipient of the liver would have to travel to the hospital where the donor had died, which could be anywhere in the country, and there was only a small window of opportunity while the liver was viable. The situation improved greatly in the 1970s with techniques to keep the liver in good condition and with more blood banks and specialist nursing staff.
But the biggest improvement came with the use of cyclosporine. Employees at the Swiss chemical company Sandoz were encouraged to collect soil samples when they travelled that could be analysed for new organisms that might have a medicinal use. A fungus found in this way gave rise to the immunosuppressant cyclosporine.
In 1977 Calne heard about it and offered to trial it in animal experiments. His team found they got particularly good results if it was dissolved in olive oil, and went on to trial it in humans. It boosted the chances of surviving for a year after a kidney transplant from 50% to 80%. The team also pioneered the use of other immunosuppressant drugs including rapamycin, 5K506 and Campath 1H.
Calne’s transplant programme grew and by the 90s his team were carrying out more than 100 liver and 80 kidney transplants each year. They were even treating children, including Ben Hardwick, who, aged three, was Britain’s youngest liver transplant patient in 1984.
As operations became more complex, Calne was cooperating with other units. In December 1986, in a joint operation with Wallwork and other colleagues at Papworth hospital, Cambridge, he gave a liver graft to a woman who was also having a heart and lungs transplant.
Calne was born in Richmond, Surrey, the elder of two sons. His father, Joseph, who had been a car engineer with Rover, owned a garage and encouraged his son to take engines apart. His mother, Eileen (nee Gubbay), was determined that Roy and her younger son, Donald, should have the chance denied to her to go to university and Roy said “she was a severe tutor to my younger brother and myself”. Donald later became a leading neurologist in Canada.
Roy was educated at Dulwich prep school based in south London, which was evacuated to north Wales during the second world war, and Lancing college, West Sussex, again evacuated to Ludlow, Shropshire. At Lancing, he enjoyed nature and life sciences, and kept a flock of 40 pigeons in the attic of the school chapel.
From the age of 12 Calne, who said he was “fascinated by the human engine”, knew he wanted to be a surgeon. When he was 16 he was accepted to study medicine at Guy’s hospital in London, where his fellow medical students – demobbed soldiers from the second world war – were nearly a decade older than himself.
After qualifying, Calne joined the Royal Army Medical Corps in 1953 to do his national service with the Gurkhas. His girlfriend Patsy (Patricia) Whelan, a nurse at Guy’s, had also managed to get stationed in the far east with the Queen Alexandra’s Royal Nursing Corps and the couple married in 1956 in Hong Kong. They would go on to have four daughters and two sons.
From childhood, Calne had always enjoyed painting. In 1988 he operated on the distinguished Scottish painter John Bellany, who following his liver transplant made 60 portraits of himself in hospital. He gave Calne lessons and they painted each other. Painting grew into an immensely therapeutic hobby for Calne, who painted many of his transplant patients, finding it brought a different, more humane quality to the relationship, particularly with his child patients. In 1991 he had an exhibition, The Gift of Life, at the Barbican in London.
Calne was elected FRS in 1974, knighted for services to transplant medicine in 1986 and in 2014 won the Pride of Britain lifetime achievement award. He continued to be outspoken on subjects such as transplant ethics, NHS management and the world’s growing population (writing a book, Too Many People, on the subject that was published in 1994).
Following his retirement from the NHS, he became professor of surgery in Singapore. He kept in close contact with other transplant doctors and surgeons across the world, notably the US transplant surgeon Thomas Starzl, and in 2012 Starzl and Calne shared the Lasker DeBakey prize (sometimes known as the “pre-Nobel”) for liver transplantation.
Calne is survived by Patsy, their children and his brother, Donald.
• Roy Yorke Calne, surgeon, born 30 December 1930; died 6 January 2024
