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In View: People in Transplantation

Leslie Brent, PhD

Professor Emeritus and Emeritus Editor of Transplantation

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doi: 10.1097/TP.0000000000000695
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Transplantation: What event or person led you into the field of transplantation?

LB: I was an undergraduate student from 1947 to 1951 in the Department of Zoology led by Professor P.B. Medawar, having just been released from my army service. He was a charismatic lecturer, teaching us statistics, embryology, and immunology. I had planned to become a school teacher and had already applied for a postgraduate diploma in education at Cambridge University. Toward the end of my studies, Medawar who, unknown to me, had already nominated me for the Vice Chancellor’s Prize for the most outstanding undergraduate of the year (I had been president of the Students’ Union and played lawn hockey for the university), asked me whether I would like to join him as a postgraduate student. I jumped at the idea and duly abandoned my plan to become a teacher.

It was Medawar, then, who was responsible for setting me off on my career as an immunologist, and I had the privilege of collaborating with him for 11 years.

Transplantation: What was the experience which was the most formative in your career?

LB: In 1951, Medawar, R.E. Billingham, who was already a Research Fellow, and I set out to study experimentally the phenomenon of immunological tolerance, which R.D. Owen had shown to exist naturally in cattle dizygotic twins in a short paper published in Science in 1945.1 Medawar and Billingham and 2 other colleagues had also become aware of its existence when, quite independently, they showed in 1950 that cattle dizygotic twins have a natural tolerance to each other skin grafts. The 3 of us therefore set out to study the phenomenon experimentally and to prove that tolerance could be induced experimentally in fetal or newborn mice and in chicken embryos. These extensive studies were carried out at University College, London, and our first paper was published in Nature in 1953.2 The tolerance studies made it possible to think that ways and means of inducing tolerance might eventually become a reality in adult animals and in the clinic, and the quest for the “holy grail” continues, with increasing hope, to this day.

The tolerance studies were undoubtedly the most challenging, important and formative in my career.

Transplantation: What was the best experience in your career?

LB: I think that this question is largely subsumed by my answer to the previous question. But to be more precise, the best experience was almost certainly the day on which we discovered that some of the mice we had inoculated in utero with allogeneic spleen cells had donor strain skin grafts that far exceeded their normal lifespan. It was a “eureka” moment: after quite a few months of experimentation this was our first indication of success.

Transplantation: When did you first read transplantation? Do you read the journal cover to cover, or target the papers that interest you?

LB: I read Transplantation from its very first number—it was at that time the only journal devoted to the science and practice of tissue and organ transplantation. It was preceded by Transplantation Bulletin, which reported largely on developments in the science of transplantation. In the early years (1950–1968), virtually all research in the field was devoted to the science, and even when the Bulletin was transformed into the Journal, there were very few papers on clinical transplantation. I was its sole European editor from 1963 to 1967—a job that now requires the attention of a clutch of editors.

That the majority of papers in Transplantation are of a clinical nature is a clear indication of how the field has developed in the last 40 years. When I read the journal these days, I need to be very selective.

Transplantation: Where do you expect the greatest advancement in the field in the next 10 years?

LB: Looking into the crystal ball is not without its dangers! In the 1980s, I predicted that immunological tolerance would make itself felt in the clinic, and that turned out to be premature. I would list 3 important likely developments that will push the field forwards. First, the routine induction of donor-specific tolerance in transplant recipients; second, the increased use of stem cell therapy; and third, the development of artificial organs, even though I doubt that highly complex organs can be replaced by artificial organs.

Transplantation: What is your advice to the young clinician/scientist in transplantation?

LB: My advice to young clinicians/basic scientists entering or thinking about entering the field is, most importantly, that there is still a great deal to be done before we achieve all our goals and make organ transplantation routinely successful and totally safe. The field continues to need intelligent and innovative people, both in the clinic and in the lab. To basic scientists in particular I would say: go for the big issues, even if at the time they seem to be out of your reach and even if they are not especially popular with grant-giving bodies. What may seem unimportant 1 year may be of the greatest consequence in 10, 20 years on. Tolerance is a very good example of this. When we carried out our studies in the 1950s, we thought of them of the greatest academic interest but had no idea that half a century later, serious attempts would still be made to carry our ideas into the clinic.

Transplantation: What is the one thing new people in the field should know?

LB: Think of really important issues that need to be resolved, and tackle them without being sidetracked by the plethora of automated equipment that can churn out masses of data that may be unimportant or irrelevant. It is creative ideas that matter.

Transplantation: Why should people aspire to a career in the transplantation field?

LB: Organ transplantation and the science underlying it represents one of the greatest advances of the 20th and (so far) 21st centuries in the history of medicine. By entering this exciting field, you can make your own distinctive contribution—there remains much to be done. Don’t listen to the sceptics who claim that there is little left to do except to dot the Is and cross the Ts! That prediction has been made before by distinguished people in the field and been shown to be false.

REFERENCES

1. Owen RD. Immunogenetic consequences of vascular anastomoses between bovine twins. Science. 1945; 102: 400–1.
2. Billingham RE, Brent L, Medawar PB. ‘Actively acquired tolerance’ of foreign cells. Nature. 1953; 172: 603–606.
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