The history of transplantation reflects a simultaneous improvement in surgical technique and immunology. With a better understanding of innate immunology and armed with tools to modify this response to antigen, Joseph Murray and J. Hartwell Harrison were first able to perform a successful allotransplant in 1954: a kidney transplant in identical twins. Although immunosuppression was not needed in this case, cortisone was utilized in transplants until 1959 when azathioprine was identified. Subsequently, the first pancreas transplant was performed by Richard Lillehei and William Kelly in 1966 and the first liver and heart transplants were performed in 1967 by Thomas Starzl and Christian Barnard, respectively. More powerful immunosuppressants, such as cyclosporin, rapamycin, and tacrolimus, discovered in the 1970s and 1980s, heralded an improved survival in allograft recipients as well as a more aggressive surgical approach. In 1981, Bruce Reitz performed the first heart-lung transplant; in 1983, the first lung transplant was performed by Joel Cooper, and, more recently (in the twenty-first century), hand and face transplants have found success.