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Cardiff
By Renal NurseMrs. Pam Davies. (retired)

Mr David Crosby was the first transplant surgeon is and was initially based at Llandough, the first transplant was done in approximately 1967. He then moved to Cardiff Royal Infirmary. The first renal physician was Dr John Henry Jones, followed by Dr Gerry Coles. They were also based on the old CRI.
It was not until the early 1970s that both departments moved to the Heath Hospital.

 

By Dr. John Henry Jones

I was appointed a physician at the Cardiff Royal Infirmary in 1967. Although not a dedicated Nephrologist, one of my main tasks was to set up a regular dialysis unit, which I ran for 6 years before moving to the University Hospital of Wales as a general`physician. There was no suitable space available at the Royal Infirmary for a dialysis unit so we had to build it on a very`attractive and popular tennis court. Later, when we had an outbreak of hepatitis and had to have a separate unit for those infected, we took over the consultants' common room. As you can imagine, neither move was universally popular! It was a 10-bed unit and soon after it opened we began training patients for homedialysis. A second consultant, Gerald Coles, was soon appointed, and when I moved in 1973 David Fisher joined him. The Unit is now in the University Hospital and run by Richard Moore. David Crosby established the transplant unit and we worked very closely together until he,too, moved to the University Hospital, as a general surgeon, in 1973.  Prof. John Salaman then ran the transplant unit but he retired  some years later. Richard Moore is now the physician in charge of the unit.

 

Transplantation in Cardiff
by John Salaman

During the late 1960’s kidney transplantation began to be offered to patients with renal failure who were on chronic dialysis programmes. In Cardiff the first kidney transplantation was carried out in 1967 by Mr David Crosby, a surgeon appointed to Llandough Hospital on the outskirts of Cardiff. David had just returned from having spent a year at the Peter Bent Brigham Hospital in Boston, Massachusetts, USA. He had a wonderful early success with a gentleman of Spanish origin called Juan Bossano. He survived for almost thirty years with a cadaveric renal transplant, ultimately succumbing to a ruptured aortic aneurism. The standard immunosuppression then was Azathioprine and Prednisolone, which was not very effective at suppressing rejection. Only 45% of these grafts would survive for more than one year. Patients regularly developed life-threatening infections resulting in a 30% mortality. In 1969 David Crosby moved his practice to the Cardiff Royal Infirmary (CRI) which was the principal hospital at the time and was the centre for carrying out haemodialysis. A four bedded annex on Ware Ward was assigned to David, and this became the Renal Transplant Unit for thirteen years.

David was aware that he could not carry on indefinitely as a single handed transplant surgeon, and began seeking a partner. The Professor of Surgery at that time was Professor Pat Forrest, and he was anxious that this new appointment should have an academic interest. It was not uncommon at that time to draw up contracts for individuals that would incorporate both service and academic responsibilities. So it was that the new transplant surgeon would be 9/11ths NHS and 2/11ths Academic, carrying the title of Senior Lecturer in Transplantation. Mr. John Salaman was appointed to this job and took up his post in October 1970. John had trained with Professor Roy Calne in Cambridge and had spent two years as a research fellow carrying out kidney transplants in rats. He had moved to the London Hospital in 1969 where he held a lecturer post on the Professorial Surgical Unit.

Over the next few years David Crosby became less involved in transplantation. Unfortunately there was little support at that time from hospital managers for appointing another transplant surgeon. However they would support the appointment of a surgeon to a sub consultant grade called an Associate Specialist. Mr Peter Griffin had held a junior post in transplantation in Cardiff and was subsequently appointed to this new post. This arrangement worked well right up to the retirement of Mr. John Salaman, now Professor Salaman in 1994. Apart from Professor Salaman and Mr. Griffin, the transplant team also comprised a Senior Registrar, a Research Fellow and a Senior House Officer, plus administrative and secretarial services. A Transplant Coordinator was appointed some time later, funded by the Kidney Research Unit Foundation (KRUF).

This charity also supported the building of a new nine bedded Transplant Unit. There had been an isolation Ward at the Cardiff Royal Infirmary, which was used to nurse highly infectious cases. It was part of the hospital complex but could only be entered through an outside door. The ward became vacant in 1972 when the University Hospital of Wales opened and accepted most of the acute services, but not Nephrology, Dialysis or Transplantation. Plans were therefore prepared to convert this area into a Transplant Ward, which involved building a new interior staircase and lift. KRUF used the services of the daily Echo and South Wales Argos newspapers to seek donations to the building fund, and in eight week £120,000 was raised. The new unit was opened by the Secretary of State for Wales, Mr Nicholas Edwards in 1982.

The main beneficiary of KRUF’s fundraising, apart from the transplant unit, was the KRUF Institute of Renal Disease. This was located at the CRI within the side building that previously housed the Department of Medicine, prior to its move to the new hospital. The head, Professor William Asscher (later Sir William Asscher) kindly offered the ground floor and the top floor for transplantation research. John Salaman and his technician would undertake kidney transplants in rats in the ground floor laboratory, whilst the top floor was used for Transplant Immunology. He had been successful in attracting a number of grants to support this work, including a major Programme Grant from the Medical Research Council. The main research effort was to develop better Immunosuppressive drugs protocols, in the hope that these could be applied to clinical situations. The eventual discovery of Cyclosporin by Professor Burell in the Sandoz laboratories in Switzerland transformed transplant practice and the Cardiff unit was able to participate in a number of clinical studies using this agent. It was only after the introduction of Cyclosporin that transplant and patient survival rates improved substantially.

John Salaman was obliged to retire from ill health in 1992. Soon after the CRI was closed and transplant services were transferred to the University Hospital with little or no prior planning. This caused John’s successor, Miss Rosanne Lord, to resign in protest.

It can be said that the transplant service at the CRI was well regarded and certainly punched above its own weight. By the time of his retirement John Salaman and his team were performing 90 kidney transplants a year, and had performed over 1500 transplants since the unit’s inception. In addition they had commenced a programme pancreatic transplantation for sufferers of diabetic renal failure. The thousandth’s kidney transplant was to a wealthy owner of a large Chinese restaurant who subsequently invited the whole team back to his restaurant to celebrate. The clinical and research teams published over 130 papers, and John Salaman was an author of five books and 14 chapters for books.

 

 

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