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Jobs’s Cancer Combined With Transplant Carries Complications

Jobs's Liver Transplant, Complicated by Cancer
Steve Jobs is seen here in this Sept. 9, 2009 file photo following liver transplant surgery. Photographer: Tony Avelar/Bloomberg

Jan. 18 (Bloomberg) -- The form of cancer that Apple Inc. Chief Executive Officer Steve Jobs announced he had more than six years ago grows and spreads slowly and, in some patients, the migrating cells aren’t detected for years, doctors said.

Jobs, who announced yesterday he was taking a leave of absence, had a liver transplant in 2009. That’s a strategy sometimes taken to stop neuroendocrine tumors that have spread to that organ, said John Fung, chairman of the Digestive Disease Institute at the Cleveland Clinic in Ohio. The disease recurs in about half of those patients, he said.

“That would be the major concern,” said Fung, who hasn’t treated Jobs and doesn’t know the details of his case, in a phone interview yesterday. “It wouldn’t be a total surprise.”

Neuroendocrine cancer, which strikes about 3,000 Americans a year, produces high levels of hormones that disrupt digestion and other body functions. Jobs’s medical troubles first became public after a 2004 statement, when he indicated his tumor was caught and removed. The Apple chief hasn’t given a reason for the liver transplant he underwent.

The leave of absence taken by Jobs yesterday was his third since 2004. He has been unable to keep on weight as he undergoes treatment for his conditions, according to a person with knowledge of the situation who requested anonymity because the matter is private.

Steve Dowling, a spokesman for Cupertino, California-based Apple, declined to comment beyond a company statement that didn’t include specifics on Jobs’s health.

Infections, Side Effects

“Whether the weight loss is suggestive of a recurrence of the cancer, that’s speculation,” Fung said, noting that weight loss may result from a variety of causes, including viral infections or drug side effects.

In the e-mail to Apple employees, Jobs said he will remain CEO while Chief Operating Officer Tim Cook will take over the company’s day-to-day operations.

Patients who undergo liver transplants can experience “countless” difficulties for years afterwards as they undergo drug treatment and face possible organ rejection, said Linda Sher, a surgeon at the University of Southern California Liver Transplant Program in Los Angeles, who hasn’t treated Jobs and doesn’t know the details of his case.

“The number of complications that can occur are from here to the sky,” Sher said yesterday in a phone interview. “I could spend all day listing them.”

The Apple chief received the liver transplant at Methodist University Hospital in Memphis, Tennessee. The surgeon who performed the procedure, James Eason, is an expert in treating recurrences of neuroendocrine tumor. He didn’t return a call to his office yesterday seeking comment.

Bile Duct

Liver surgery usually involves cutting and reconnecting the bile duct, a tube in the body that transports the digestive fluid. Blockages in the duct sometimes occur at the site where it was stitched back together, Sher said.

Other complications can occur long after the original surgery and can take a number of forms, according to Sher, who is conducting a study to determine which neuroendocrine tumor patients are most likely to benefit from getting a new organ.

Transplant patients must also take drugs to prevent the immune system from attacking and rejecting the new organ, she said. Because they dampen the body’s disease-fighting systems, drugs most commonly used, cyclosporine and tacrolimus, are associated with infections, tumors and kidney damage, Sher said. Patients sometimes take other drugs, such as steroids, that raise the risk of diabetes, she said.

While most cases of acute organ rejection occur within the first six months after surgery, the risk of rejection persists for years afterwards, Sher said. Patients must see their doctors frequently to adjust transplant medications, monitor liver function and diagnose complications, she said.

“There are any number of things that can happen,” she said. “Both the patient and the doctor have to be attentive and alert.”

To contact the reporter on this story: John Lauerman in Boston at jlauerman@bloomberg.net.

To contact the editors responsible for this story: Jonathan Kaufman at Jkaufman17@bloomberg.net; Reg Gale at Rgale5@bloomberg.net

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