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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.

Source: http://www.renhist.co.uk/cardiff.pdf

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