Jobss Tumor Is Rare Reason For Liver Transplant, Doctors Say
Jobs, 54, had a transplant about two months ago, a person familiar with the matter said. Jobs said in 2004 that doctors removed a neuroendocrine islet cell tumor from his pancreas. Liver replacement may stop the cancer from spreading in some cases, said Abhinav Humar, clinical director of the Division of Transplantation at the University of Pittsburgh Medical Center.
The top 10 U.S. transplant centers have probably performed fewer than 100 of the procedures to treat the spread of neuroendocrine tumors overall, Humar said June 20 in a telephone interview. About 6,500 liver transplants were performed in the U.S. in 2005, according to the New York-based American Liver Foundation. Jobss tumor may have spread to his liver and the transplant was done to eliminate the growths, Humar said.
“These tumors often metastasize just to the liver,” Humar said. “Its the most common place where they metastasize, and for that reason its one of the rare pancreatic cancers that you can treat with a liver transplant.”
Bloomberg News reported Jan. 16 that Jobs was considering a liver transplant. Apple hasnt disclosed the exact nature of Jobss medical condition. Jobs didnt respond to an e- mail seeking comment. Apples lead directors, Intuit Inc. Chairman Bill Campbell and Genentech Inc. Chairman Art Levinson, didnt respond to requests for comment.
Vital Organ
The liver is a vital organ that detoxifies the blood, helps process food, stores vitamins and sugar, and makes hormones, according to the American Liver Foundations Web site. Most liver transplants are done to replace organs scarred by cirrhosis, according to the foundation.
Cirrhosis can be the result of drinking too much alcohol, which damages the liver, or viral liver infections. Other reasons for liver transplants include disease of the bile ducts, hereditary liver disease, and cancers that begin in the liver and havent spread beyond the organ. The foundations site doesnt list metastatic neuroendocrine tumors as a reason for performing a liver transplant.
Jobs may have had a liver transplant for reasons unrelated to his earlier cancer diagnosis, said Humar and Simon Lo, director of endoscopy at Cedars Sinai Medical Center in Los Angeles. Still, most patients with failing livers appear yellow, or jaundiced, because harmful chemicals arent being filtered from the blood, and may show swelling in the abdomen, they said.
Liver Function
The Apple executives outward appearance before the transplant hints that “he didnt have liver failure,” Humar said. “He may have had a tumor in his liver, but his liver function was normal, I suspect.”
Humar and Lo each said they have never treated Jobs and dont know the details of his case. Three liver transplant programs for children and adults at the University of Pittsburgh perform about 160 to 200 procedures a year, Humar said. Lo said he cares for post-transplant patients at Cedars Sinai.
Islets are clusters of cells in the pancreas that produce hormones. Neuroendocrine islet cell tumors make abnormal levels of hormones and can spread to other organs.
Hormone Imbalance
Jobs, co-founder with Steve Wozniak in 1976 of Cupertino, California-based Apple, said on Jan. 5 that he had been losing weight throughout 2008 because of a hormone imbalance. He called the weight loss “a mystery to me and my doctors,” in a statement Apple released then. On Jan. 14, he announced that he was taking a five-month medical leave because his condition was “more complex” than he originally thought.
Humar said he has seen data collected from transplant centers suggesting that patients do better when the spread to the liver occurs long after the initial neuroendocrine tumor appears, rather than shortly after or at the same time the primary tumor is diagnosed. That may bode well for a case like that of Jobs, who got initial treatment for his neuroendocrine tumor five years ago, Humar said.
Liver transplants can take from 6 to 10 hours, depending on how complicated they are, Humar said. Difficulties can arise both in removing the diseased liver and putting the new one in place, he said.
Transplant Prognosis
Patients can do extremely well, as shown by the career of Olympian Chris Klug, who won a bronze medal in snowboarding in 2002 just two years after his transplant, said Cedars Sinais Lo. Klug had needed a new liver because of a rare degenerative condition of the bile duct.