Aug. 21 (Bloomberg) -- Apple Inc. Chief Executive Officer Steve Jobs chose to have his liver transplant performed by a Harvard University-trained surgeon with experience treating the recurrence of a rare cancer Jobs says he had in 2004.

James Eason, head of transplantation at Methodist University Hospital and the University of Tennessee Health Science Center, said in his first interview since Jobs’s surgery that he has replaced the livers of about 10 people with the cancer, called neuroendocrine tumor. While Jobs, 54, has confirmed he had the same rare tumor treated five years ago, he hasn’t said whether the transplant was carried out to address a recurrence of the cancer.

Publicity and referrals from Jobs’s case may help Eason, 48, who trained at Harvard Medical School-affiliated Massachusetts General Hospital in Boston, expand a transplant service that has tripled in size since he came to Memphis in 2006. Eason said he has received a flurry of requests to examine patients with neuroendocrine tumors since treating Jobs earlier this year.

The tall, soft-spoken surgeon, who comes from a family of Tennessee doctors, said he can’t comment on the details of Jobs’s case because of medical ethics and privacy laws.

Jobs is “a special person” was all Eason would say about the Apple chief. “He’s really a genuinely nice person.”

Jobs lives in California’s Silicon Valley, where Apple’s headquarters are located. Responding to speculation that Jobs bypassed an organ transplant wait list by coming to Memphis, Eason denied that was the case.

‘Gaming the System’

“It’s not gaming the system,” he said in the Aug. 18 interview in Memphis. “It’s people choosing where they want their health care. Some people would leave Tennessee to go to California or somewhere else to seek treatment. Now we have people coming from California to Tennessee.”

Eason said he will only perform a liver transplant on a neuroendocrine tumor patient when certain that he can eliminate all the spreading cancer. His results with these patients have been about the same as those with other liver-cancer sufferers, about 70 percent of whom have healthy organs five years after surgery, he said.

Overall, 91 percent of Eason’s patients have healthy livers one year after surgery, compared with a national average of 87 percent. That success rate, along with Eason’s expertise in neuroendocrine tumors and research prowess, would make the surgeon a good choice, said A. Benedict Cosimi, a Harvard surgery professor who stepped down last year as director of Massachusetts General’s transplant program and trained Eason in the early 1990s.

Record of Success

“This is just an example of how if someone is good, people in the know will figure it out,” Cosimi said Aug. 19 in a telephone interview.

Eason said he performed some transplants on patients with neuroendocrine tumor during his time at the Ochsner Clinic in New Orleans. While it’s hard to specialize in such a rare cancer, since cases are so few, the experience he gained with those patients may have given him unusually high qualifications to treat a patient such as Jobs, colleagues say.

“That’s certainly more than average experience,” said John Lake, director of liver transplantation at the University of Minnesota in Minneapolis, in an Aug. 18 telephone interview. “I’ve been in the field for 22 years, and I’ve done less than five. If you have a program that has a special interest in that, you can provide better care to patients.”

Jobs declined comment on his health last year as he appeared notably thinner at company events. On Jan. 5, he said he was suffering from a hormone imbalance that was “robbing me of the proteins my body needs to be healthy.” Nine days later, he went on medical leave after saying only that his health problems were “more complex” than he thought. Job returned to work, as planned, at the end of June.

Minority Patients

Eason, whose 693-bed hospital is the largest in Memphis, said he treats a higher percentage of blacks than the national average. Last year, 15.4 percent of its liver transplant recipients were black, compared with a national rate of 10.3 percent, according to the Scientific Registry of Transplant Recipients, a national database of transplant statistics based in Ann Arbor, Michigan. While patients of Jobs’s stature are welcome, they aren’t regarded differently than anyone else, Eason said.

“Memphis is a very impoverished city in and of itself, with a large minority population,” he said. “I can tell you our floors aren’t full of billionaires.”

Eason said he’s aiming for better access to transplantation for the region’s poor, black and Hispanic populations.

Serving the Community

“A lot of our patients don’t have the means to travel outside this area for a transplant,” as many people needing organs do, Eason said in an interview at the hospital. “Now, we have many local people who had been listed for transplants in other areas and were able to get their transplants here.”

Neuroendocrine tumors, which strike only about 3,000 people in the U.S. annually, often make high levels of hormones that can disrupt digestion and other body functions, and some mature or “differentiate” into forms called “islet cell” and “carcinoid.” The cancers grow and spread so slowly that sometimes tumors that have expanded from the original location aren’t detected until years after the disease is first detected, said Linda Sher, a surgeon at the University of Southern California in Los Angeles.

In cases when the tumor spreads only to the liver, some surgeons use transplants to get rid of the cancer. The approach is still “risky and unproven,” said Richard Schilsky, a University of Chicago gastrointestinal cancer specialist and past president of the American Society of Clinical Oncology.

Not Proven Treatment

“It would not be considered the standard of care,” he said July 2 in a telephone interview. “It’s not something that would routinely be done nor is it proven to be a beneficial treatment, but it has nevertheless been tried and I’m sure in some cases been successful.”

Preliminary data suggest that neuroendocrine tumor patients with characteristics similar to those of Jobs fare particularly well after a liver transplant, said USC’s Sher, who has studied 47 U.S. patients who have undergone the procedure. Of 15 whose original tumors were removed before the transplant, spread slowly and showed signs of differentiation, 14 patients are still alive. Eight of the patients have lived more than three years, and four of them have lived five years or longer; one has lived about 15 years.

Initial Tumor

Jobs’s 2004 statement indicates that his primary neuroendocrine tumor was caught and removed. Jobs said in a statement then that he had the differentiated, islet cell form of neuroendocrine tumor.

“Patients with neuroendocrine tumor can do just as well after a liver transplant as patients who undergo one for any other reason,” Sher said in a telephone interview. “We have to learn to select patients that are most likely to have a good outcome.”

Eason assumed leadership in Memphis after Hurricane Katrina destroyed his New Orleans transplant practice at Ochsner in 2005. While rising floodwaters halted just outside Ochsner’s doors, rain poured into the building through the hospital lobby’s skylights, and his transplant clinic closed for a month.

He slept in his hospital office for weeks in an effort to revive the transplant service. Flood damage to the region’s organ procurement network offices was catastrophic, Eason said. Most of his patients left the area or began seeking transplants elsewhere.

“I could see it wasn’t going to be a good place to practice for a long time,” he said.

Organ Supply

In Memphis, Eason found a valuable supply of livers for transplantation, said John Fung, chairman of transplant surgery at the Cleveland Clinic in Cleveland. While the University of Tennessee boasted the third-oldest liver-transplant program in the country, the state’s programs were relatively small.

“They were a net exporter of livers,” Fung said. “Going into a situation like that, you have the opportunity to use the donors in your own area, and he’s been very successful at doing that. He took advantage of the opportunity and built the volume in Memphis.”

In 2005, the year before Eason arrived, there were 35 liver transplants done in Memphis; in 2006, when he took over the program in April, there were 40. In his first full year the program conducted 97 liver transplants, last year there were 120 and so far this year 90 have been done, Eason said.

“It’s amazing what he’s built there over the last couple of years,” said Harvard’s Cosimi.

To contact the reporter on this story: John Lauerman in Boston at jlauerman@bloomberg.net; Connie Guglielmo in San Francisco at cguglielmo1@bloomberg.net

Last Updated: August 21, 2009 00:01 EDT