Originally published in Volume 36 Issue 10 of Artificial Organs, 04 October 2012
After completing my internship, I got my first position as a scientific assistant at the medical clinic of the University of Munich in April 1960. Because there were many more candidates than positions, the salary for the post was divided equally among the four doctors who were selected. Nevertheless, I was overjoyed to be one of the four. In addition to the regular clinical duties as a doctor at the University, it was expected that the scientific assistants should actively participate in a research project. It was possible to choose the topic. I had heard of the Hamburg-based internist Curt Moeller, who had developed the first German artificial kidney, with which he treated patients with acute renal failure. As such, I went to Hamburg and learned how to use his artificial kidney. Following this, our hospital in Munich also acquired a “Moeller Artificial Kidney”1, which was replaced two years later by the Travenol twin-coil dialyzer.
In the following years, my favorite reading became the Transactions of the American Society for Internal Artificial Organs. Through these publications, I was introduced to the work of Belding H. Scribner in Seattle, WA, USA, who had started to treat patients with chronic renal failure. I filed an application with the German Research Council for financial support in order to visit Scribner in Seattle in order to learn firsthand his treatment methods. In addition to this, I planned to visit Willem Kolff in Cleveland, OH, and George Schreiner in Washington, DC, on the way home. The application was rejected on the grounds that an educational experience could not be effective if split into three different locations. However, as I was determined to take this research trip, I had no other option than to make use of my full year’s vacation and a considerable amount of unpaid leave in order to remain in the USA for a full 6 months.
In Seattle, Cleveland, and Washington, I was warmly welcomed by all. However, of equal importance, if not of greater significance, were the lifelong friendships with my American colleagues that were founded during those visits. A particularly strong friendship bound me with John Maher who at the time was head medical assistant to George Schreiner. Although we were of same age, unfortunately he passed away at a much too early age.
Upon returning punctually to my workplace at the University of Munich, I was surprised to find out that my salary was been withheld by the University for the whole duration of my absence. Apparently, the University was of the opinion that I would not return from the USA after the 6 months. In the fall of 1963, I began a treatment program in Munich for patients with chronic renal failure. My former boss was very skeptical of the new treatment. He demanded that in the first year I should handle no more than four patients in order to prove the viability of this treatment. As luck would have it, a prominent politician was among the first four patients. Under these circumstances, it was clear that I could not entrust the care and connecting, let alone the declotting of the “plain Teflon shunts”2 to my colleagues and/or nurses. The probation year came to a successful conclusion and as such we started our program, and in the following years, we were able to educate more than 100 interested colleagues and nurses from West Germany, Austria, and Switzerland in our department in Munich.
In 1964, the founding congress of the European Dialysis and Transplant Association took place in Amsterdam, The Netherlands. Willem Kolff, the inventor of the artificial kidney, was invited from the USA as a keynote speaker. I invited Dr. Kolff to visit us in Munich following this Congress, where he gave a lecture on the topic of: “Transplantation of Cadaver Kidneys” in a Munich hotel. A total of 16 German colleagues were in attendance. The company Travenol (now Baxter) generously sponsored a total of 10 annual “Meetings for Dialysis Physicians in Munich” until 1973. Traditionally, at these meetings, both an American and a European speaker were invited. The goal of these one-day meetings was that with only two speakers the audience would have unlimited time for discussion (Table 1).
|1||10/26/1964||Munich||J.W. Kolff||Transplantation of Cadaver Kidneys|
|2||11/27/1965||Munich||J.F. Maher||Hemodialysis of Exogenous Poisoning in Nephrotoxic Acute Renal Failure|
|P. Michielsen||Some Aspects of Hemodialysis and Renal Transplantation in the Treatment of Chronic Renal Failure|
|3||10/22/1966||Rottach-Egern||J.H. Homes||Physiological Changes in Renal Failure Patients which may have important Bearing on either Chronic Dialysis or Renal Transplantation|
|4||10/21/1967||Munich||A.R. Lavender||Laboratory and Clinical Studies in Treatment of Chronic Renal Disease|
|5||10/11/1968||Bad Reichenhall||C.L. Hampers||The Artificial Kidney at Home—Problems and Perspectives|
|M.C. Legrain||Nierentransplantation -.Klinische und therapeutische Probleme im ersten postoperativen Monat|
|6||09/26/1969||Schloss Fuschl||J.P. Pendras||The Clinical Approach to Maintenance Hemodialysis|
|7||10/02/1970||Schloss Fuschl||R.G. Muth||The Development, Limitation and Benefits of a Home Hemodialysis Program|
|J.B. Dossetor||Recent Perspectives in Cadaveric Renal Transplantation|
|8||09/16/1971||Schloss Fuschl||G.E. Schreiner||Ethical Problems in Hemodialysis and Transplantation|
|H. Thielecke||Anthropologische Probleme der modernen Medizin—Grenzprobleme im Zusammenhang mit Organtransplantation und künstlicher Lebensverlängerung|
|9||09/22/1972||Munich||V. Cambi||Molecular Weight and Uremic Toxicity. The Debate on Middle Molecules|
|10||10/19/1973||Munich||J.P. Merrill||Past, Presence and Future of Hemodialysis|
|J. Crosnier||Some Clinical Aspects on Renal Transplantation|
|J.F. Bach||Perspectives in Transplantation Immunology|
In 1969, together with my colleagues Frank Parsons (UK) and William Drucker (The Netherlands), I founded the registry of the European Dialysis and Transplant Association 3, which over the years has become the world’s largest database on patients with end-stage renal failure on dialysis.
However, not only the treatment and care of renal patients, but also medical research belongs to the challenges of a University “Nephrology Department.” We were very fortunate to have the company AKZO (now Membrana) as a partner who developed and produced dialysis membranes. The laboratory experiments that had to do with human blood were conducted, not in their facilities, but rather in our research laboratory. In the beginning, the development and optimization of plasma separation membranes was conducted exclusively through “in vitro” experiments with human blood. Further investigations were carried out in the so called “online-single pass” or “ex-vivo model”4. This was developed into the “spontaneous membrane plasma separation” procedure that was later patented worldwide 5. In addition to this, the so-called “ex vivo model” was further developed by us and generally recognized later as a standard test system to assess the hemocompatibility of external surfaces. Direct blood membrane interactions were measured in miniature devices under simulated standard conditions in dialysis or hemoadsorption systems.
Hans Gurland had performed the first acute dialysis in 1961 in Munich. He then started the first chronic patient clinic in Bavaria in 1963. In the late 1960s, he was then responsible for both the first peritoneal and the first home dialysis patients in southern Germany. In 1975, he was selected to oversee nephrology, dialysis, and medical management of renal transplantation at the Klinikum Grosshadern of the University of Munich—responsibilities he fulfilled for 21 years
At the 1966 meeting of the European Dialysis and Transplant Association (EDTA), Dr. Gurland was tapped to perform a consensus of renal patients in EDTA countries. So began the EDTA registry, which has been providing archival-quality patient demographics ever since and which served as a model for later activities in other regions. The EDTA registry was physically located in Munich for much of the 9-year period during which Dr. Gurland served as its chairman.
Dr. Gurland was one of the few Europeans invited to participate in Ben Burton’s annual meetings at the National Institutes of Health in Bethesda, MD, USA. His 1981 plenary lecture at American Society for Artificial Internal Organs in Anaheim, CA was among the first invited lectures by a European at that group’s annual meeting. He began to play an increasing role in the international societies, first as a counselor of the International Society of Artificial Organs later as its president, as a founding senator of the International Faculty for Artificial Organs and then as president of the European Society for Artificial Organs.
During his professional life, Dr. Gurland has served on the Editorial boards of 14 scientific journals. He is the author or editor of 10 books, including the first German-language textbook of dialysis. Furthermore, he is author or coauthor of 395 publications.