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TRIBUTE: Professor R. Küss, 1913–2006

2007; Elsevier BV; Volume: 7; Issue: 12 Linguagem: Inglês

10.1111/j.1600-6143.2007.02002.x

1600-6143

B Charpentier,

Organ Transplantation Techniques and Outcomes

Rene Küss was a larger than life figure in the world of transplantation, and his contributions, including his invention of the universally used renal transplantation technique will long be remembered. Rene Küss was a larger than life figure in the world of transplantation, and his contributions, including his invention of the universally used renal transplantation technique will long be remembered. René Küss, one of the ‘fathers’ of organ transplantation, an honorary member of ESOT, was born on May 3, 1913, and died on June 20, 2006, in Paris, France, at the age of 93. Rather than following the history of Prof Küss' career, it would be more appropriate to consider the main aspects of his huge personality. The word ‘fear’ was absent from his vocabulary. He had no fear in 1940 during the Mers El Kebir battle in the Second World War, when the destroyer ‘Mogador’ on which he was a surgeon, was sunk; he was one of the survivors. He had no fear when in 1954, during the car race ‘Tour de France Automobile’, he crashed his car by driving for too long and spent several days in a comatose state. He was also not afraid to make inventions in the operating theater. He invented two surgical techniques that will remain with us forever: the Boari-Küss technique for the ureter elongation; and the Küss technique for kidney transplant graft implantation into the extraperitoneal site in the iliac fossa, and anastomosing the renal artery and femoral artery, completely at variance with the graft implantation to the inguinal site, as developed by D. Hume. This boldness appeared very early in the life of René, especially with respect to medicine. Medicine and surgery were a long family tradition, and René's father was head of the general surgery division in the ‘La Charité’ Hospital in Paris, which years later became Hôpital Broussais. Thus, it was natural for him to become a surgeon. Some students only chose this career at the age of 25, but René's first visit to an operating theater, his father's unit, was at the age of 7. It was then he decided to become a surgeon, and entered medicine as if it were a religious vocation. He graduated from the University of Paris, School of Medicine, and served as a resident surgeon at the Broca Hospital, Paris, under the Service Head, Professor Robert Proust, the brother of the famous French writer Marcel Proust. He became ‘interne des Hôpitaux de Paris’ in 1939, at a time when the progress in surgery, anesthesiology, radiology and other disciplines was growing exponentially. Professor R. Küss When the war came, he did his military service in the French army, and he still continued to operate. He later led the surgical team of General Patton's 3rd American Army and participated with the French Resistance in the liberation of Paris, alternately manipulating scalpels and grenades. After the war, René took the post of Assistant in the service of Professor Fey, Chief of Urology, at Cochin Hospital. Thereafter, his career was dedicated to urology because renal cavity opacification, namely i.v. pyelography, appeared in 1937, and urological operations were, for the first time, preceded by an exploratory phase: radiological diagnosis. Several years later, René became full professor of surgical pathology. When the post of Chief of Urology became vacant at both St. Louis Hospital and at Foch Hospital, René created a multiple department of urology in the Paris Hospitals. Then came the historic 12-day period in January 1951 when René Küss, Charles Dubost and Marceau Servelle in Paris first performed the extraperitoneal renal transplantation procedure in common use today, and which is called the ‘Küss operation’. Oeconomos and Rongeulle, from the teams of Dubost and Servelle had helped Küss to develop the operation in the experimental laboratory. Dubost and Servelle obtained their renal allografts from the same guillotined convict donor, whereas Küss used a kidney that had been removed from another patient for therapeutic purposes. Of a total of nine patients transplanted, all nine patients rejected their graft and Prof. Küss predicted in his famous publication in Mem. Acad. Chir (1Kuss R Teinturier J Milliez P Some attempts at kidney transplantation in man.Mem Acad Chir (Paris). 1951; 77: 755-764PubMed Google Scholar) ‘about some cases of renal allograft in human’…‘in the present state of knowledge, the only rational basis for kidney replacement would be between monozygotic twins…’ Prof. Küss was right at the time, because allogeneic transplantation was performed successfully without any immunosuppression and only in the compatible blood group A, B and O system. Like Jaboulay, Voroney and others who had worked with xenotransplantation, René came up against what was to become a new discipline: immunology, and transplant immunology is the most complicated aspect of immunology. The first success was achieved by Dr. J. Murray in 1959 in Boston with monozygic twins, and then with dizygotic twins with total body irradiation. Five months later, J. Hamburger's team in Paris succeeded, and in 1960 Prof. Küss obtained the first long-term graft survival (18 months was an achievement at that time!) in three allograft recipients. In 1960, Prof. Küss was the first to use the immunosuppressive regimen based on chemotherapy invented by Drs. Tom Starzl and Roy Calne, namely, 6-mercaptopurine and prednisone. Prof. Küss also worked on graft perfusion with blood, and on warm and cold ischemia in animals. He also contributed substantially with Mollaret and Goulon to the concept of ‘brain death’ and recovering perfused organs from a deceased donor. In 1966, he did his first xenotransplantation, a pig kidney into man. The outcome was hyperacute rejection; the ignorance of xenoantibodies at the time recalled the first experiment of Jaboulay in Lyon in 1906, when he transplanted a goat kidney into a young uremic patient by anastomosing the renal artery to the humeral artery at the elbow. Afterwards, René accumulated several inventions and honors, creating the French Transplantation Society in 1971, and becoming President of the French Academy of Medicine in 1988. He received the Medawar price in 2002 from the hands of his friend, Dr. Tom Starzl. René Küss was not only a giant in the operating theater but he was also a hunter, an explorer, and most of all a connoisseur of fine arts, particularly paintings, having been introduced to the arts by his father. As early as 1933 at Honfleur, he was befriended by the main French painters, Dufy, Friez, Saint Delis, Gernez and Herbo. He subsequently became President of the Honfleur Artists Society, which ran famous historical retrospective exhibitions, including one for Boudin in 1992. René himself had one of the most beautiful private collections of paintings, worthy of a museum. René Küss received the War Cross with palm leaves, and was appointed commander of the French Legion d'Honneur. His family, his professional activities and his devotion to arts had filled his life over a span of 93 years to a level almost never achieved by any man or woman. All the transplant community must thank him and remember him for the ages.