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Epilogue

A Memorable Healer and a Challenging Case

By E. Richard Stiehm, MD

We lost a giant of medicine last year, a healer who was not a physician but whose work has saved countless lives. Paul Terasaki, PhD, was a pioneer in transplant medicine and the father of tissue typing. He was 86 years old when he died. His legacy continues in the lives of the patients now and in the future who are touched by his innovation and brilliance.

 

 

Life Magazine article from 1971

Read about Maurice Elias and his transplant here »

 

 

Among those patients was a child whose case was one of the most challenging of my career. I first met Dr. Terasaki in 1970, when 3-month-old Maurice Elias came to UCLA following oral thrush — a common fungal infection — that developed into pneumonia, but which, in spite of antibiotics, would not resolve. Our X-ray and biopsy studies revealed that the child had Pneumocystis carinii, a rare fungus that causes pneumonia only in immunocompromised patients. Further studies showed a small thymus gland, low gamma globulin levels and poorly functioning lymphocytes, all indicating that the child had no immunity — severe combined immunodeficiency (SCID), better known as “baby-in-the-bubble syndrome.”

A bone-marrow transplant was the only hope for Maurice, but the procedure had only been done successfully in a SCID patient once before. For it to be successful, we needed a donor with lymphocytes that exactly matched Maurice’s cells. Unlike red blood cells, however, for which there are only four types, lymphocytes — known as human leukocyte antigen (HLA) types — have several thousand variations. Our best chance of finding a perfect match would be from a sibling with common parents.

Enter Dr. Terasaki. At UCLA, he pioneered HLA typing, establishing a typing laboratory here in 1969. When I contacted him about Maurice, he told me to bring blood samples from the child, his parents and his four siblings. I hand-delivered samples to his laboratory because I wanted to meet him in person.

  Dr. Paul Terasaki
  Dr. Terasaki, Terasaki Life Science Building
  Dr. E. Richard Stiehm
 

Top: Dr. Paul Terasaki working with a student in his lab in 1970. Photo: Courtesy of One Lambda. Middle: Dr. Terasaki outside the Terasaki Life Science Building. in 2010. Photo: Courtesy of Leslie Barton. Bottom: Dr. E. Richard Stiehm is professor emeritus of pediatrics in the Division of Allergy, Immunology and Rheumatology. He has been on faculty at UCLA since 1969. Photo: Courtesy of Dr. E. Richard Stiehm

Dr. Terasaki, a bespectacled, soft-spoken man, greeted me warmly. Before telling him about Maurice, I asked about his own background — he was born and grew up in the Boyle Heights area of Los Angeles and during World War II was interned for three years with his family in Arizona’s Gila River Relocation Camp — and how he ended up, with a PhD in zoology from UCLA but no medical degree, as a professor in the Department of Surgery. He was hired by the department, he told me, to study ways to prevent graft rejection of kidney transplants. Following a postdoctoral year in London with Sir Peter Medawar, who shared the 1960 Nobel Prize in Physiology or Medicine for identifying HLA, Dr. Terasaki returned to UCLA to develop methods for HLA typing.

Dr. Terasaki initially said he was optimistic about finding a matched donor among Maurice’s four siblings, but repeated typing resulted in three different results, none matching his parents or siblings. “It’s never happened before,” he said. “Don’t do a transplant.”

I delivered the sad news to the parents and sent the child home on antibiotics, antifungals and weekly gamma globulin injections. Maurice remained sickly, and he was back in the hospital at nine months of age with persistent vomiting. The fungal infection had extended down his esophagus, preventing him from swallowing. I called Dr. Terasaki again about finding a donor. He requested more blood, so we sent him three more small samples. He typed Maurice repeatedly, and up to 16 different types showed up (a normal result has only four: two from each parent). After comparing all these results, Dr. Terasaki noted that three types showed up repeatedly, and that these were identical to those of his 13-year-old sister Tami. “I think Tami might be a match,” Dr. Terasaki told me. “We can test that by mixing their bloods together to see if Tami’s cells recognize Maurice’s cells as being foreign.” One week later, he said, “I think Tami is a perfect match. But I can’t be 100 percent sure.”

Maurice’s parents agreed to go forward with the transplant. The child’s father, a Hollywood actor and stuntman, had kept his co-workers informed about his child’s illness, and now one coworker told a LIFE magazine reporter of the proposed transplant, and LIFE contacted the parents to see if they would agree to a story about Maurice before, during and after the procedure. So with a LIFE photographer present, Tami was admitted to the hospital, where a hematologist used a large-bore needle to extract four ounces of marrow from her hip and breast bones. The cells were taken to Maurice’s crib and injected into his abdominal cavity, from where they would migrate to the liver, spleen and bone marrow.

Two weeks passed, and the candida in the child’s mouth spontaneously disappeared. Then, a crash, as Maurice developed signs of graft-versus-host reaction. But two weeks later, after various rounds of therapy, he improved, and follow-up tests showed that the graft had taken. We sent Maurice home, apparently cured.

What a milestone this case would be. Maurice’s transplant was the first of more than 4,000 similar transplants to be done at UCLA for children and adults, and the procedure, which today is known as stem-cell transplant, also is used in other diseases, including leukemia, lymphoma and genetic diseases such as sickle cell anemia. The UCLA tissue-typing laboratory founded by Dr. Terasaki is busier than ever.

Dr. Terasaki retired from UCLA in 1999. Fifteen years earlier, he and eight of his former students founded One Lambda, which developed tissue-typing trays and reagents for other transplant units. Not long after he retired, Dr. Terasaki established the Terasaki Foundation Laboratory to study and solve the problem of organ-transplant rejection and failure. And there’s also the Terasaki Center for Japanese Studies and an endowed chair in the UCLA Department of Surgery. The Terasaki Life Science Building, for which he and his wife were major contributors, is named in his honor.

He was a man of great vision, warmth and generosity. Maurice and all the patients who have benefited from his contributions owe him a deep debt of gratitude, and we, his colleagues and friends, owe him our deepest respect.

 





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