In the early 1940s a young father died days after kidney shut-down from two sulfa pills. 

  • In 1948 an Army womans poisoning suicide attempt saved by one of the first artificial kidneys.
  • A bright Korean-American laboratory technician at Iowa saved in 1967, when his brother flew in from Korea and donated a kidney. 
Slow steady progress. 

The Nobel Prize in Medicine was awarded to Peter Medawar in 1960, to Joseph Murray in 1990 and to George Hitchins and Gertrude Elion in 1988 for some of the discoveries that led to these advances.

Peter Medawar in Glasgow, stimulated by the rejection of skin grafts in World War II RAF pilot burn victims, incriminated the immune system in rejecting skin grafts.

Later he inoculated mouse embryos with unrelated mouse skin and found that they would accept skin grafts in adult life from these foreign mice, due to immune tolerance.

Wilhelm Kolff, who did not win the Nobel Prize but should have, (in the Netherlands in 1943 to 1945) 

Wilhelm Kolff

circulated the blood of kidney failure patients through cellophane sausage skins in a salt water bath to free it of body waste and returned it to patients who recovered from kidney failure.

Some of this was based on work done by Abel in Baltimore and Haas in Giessen.
Kolff gave renal dialysis apparatuses to medical units in the UK, the US, and Canada.

Joseph Murray in Boston, removed kidneys from dogs and put them back successfully.
Then in 1953 he gave a kidney from brother Ronald to identical twin Richard Herrick with kidney failure.
The kidney worked well, and Richard no longer required dialysis. He did several more twin transplants successfully. Then he tried 91 transplants from near relatives.
Only 5 lived.
Worse still only one renal failure patient receiving a transplant from a cadaver survived!
Success had to await new drugs and tissue matching techniques.

Dr. William Damashek, a Boston hematologist, needed drugs to treat children with leukemia in the late 1950s.
He appealed to George Hitchins and Gertrude Elion of Burroughs-Welcome who designed mercaptopurine (6MP) to block purine production in DNA needed for cell nuclei.
A new kind of immune tolerance was born.

Roy Calne at the Royal Free Hospital in London used 6 MP to make dogs tolerant so that they lived six weeks instead of one after a transplanted kidney.
One out of three patients treated with 6 MP lived a few weeks.
A newer better DNA blocker azothioprine (1962) allowed one patient to return to work. Finally Thomas Starzl, an Iowan working in Colorado in the 1960s using azothioprine and bursts of steroids reported 27 survivors out of 33 transplants. Fifteen lived at least 25 years.

Cyclosporine, an immunosupressant antibiotic from a fungus found in 1979, improved results and reduced the need for steroids.

The National Network reported on 93,934 kidney transplants with related donor kidneys surviving one year in 94% and half lasted 36 years.
Also cadaver kidneys survived one year in 88% and half lasted 20 years.
Over 10,000 kidney transplants are now done yearly in the United States.