From Our 2009 Archives
Steve Jobs' Reported Liver Transplant
Newspaper Reports Steve Jobs Had a Liver Transplant Recently; Doctors Weigh In
Reviewed By Louise Chang, MD
June 22, 2009 -- The Wall Street Journal reports that Steve Jobs, Apple's chief executive officer, had a liver transplant in Tennessee about two months ago.
The report has raised questions about Jobs' health.
Apple didn't reply to queries from WebMD about Jobs' reported liver transplant. The Wall Street Journal quotes an Apple spokeswoman as saying that Jobs looks forward to returning to work at the end of June. Her statement didn't confirm or deny a liver transplant.
Jobs hasn't revealed many details about his health over the years. But he has acknowledged having surgery in 2004 to remove a pancreatic tumor, which he called a very rare form of pancreatic cancer called an islet cell neuroendocrine tumor.
On Jan. 5, 2009, Jobs posted a letter on the Apple web site stating that he was being treated for a "hormonal imbalance," but he didn't specify what hormones were involved or whether the problem was linked to his previous pancreatic cancer.
On Jan. 14, 2009, Jobs announced that he would take a medical leave of absence until the end of June from his role as Apple's chief executive officer in order to focus on his health. In a letter posted on Apple's web site, Jobs said he'd learned that "my health-related issues are more complex than I originally thought," but he provided no details about his condition.
Transplant Experts' Views
For insight into Jobs' reported liver transplant, WebMD spoke with liver transplant surgeon Ari Cohen, MD, of the Ochsner Clinic Foundation in New Orleans and Abhi Humar, MD, clinical director of the Thomas E. Starzl Transplantation Institute at the University of Pittsburgh Medical Center. Neither doctor is treating Jobs.
Both doctors agree that islet cell tumors -- the type of tumor Jobs had removed in 2004 -- can spread to the liver.
"If they're to spread, that's probably one of the most common places where they do spread," Humar says.
Humar says when those tumors spread to the liver, they can be surgically removed, "but if they've spread to multiple places in the liver, then the liver transplant is an accepted form of treatment for that."
Cohen says that a liver transplant would usually only be done after other treatments -- including chemotherapy and repeated surgeries -- fail.
Humar says chemotherapy doesn't have good response rates for this type of tumor. "It isn't a good option, but it's an option," Cohen counters. "He's correct, but it's still offered to some patients."
Surgeons can transplant a whole liver from a deceased donor or part of a liver from a living donor. The Wall Street Journal didn't report details about Jobs' liver donor.
Shortage of Liver Donors
There are many more people awaiting liver transplants than there are donated livers. "That's probably the biggest challenge," Cohen says.
The system that determines who gets a liver first prioritizes the sickest patients first.
"Some patients who have very severe illness and are tremendously sick could get transplanted with a few days, for example, whereas other patients who are not as sick and their liver disease hasn't progressed as far may end up waiting several months to sometimes several years," Humar says.
Jobs reportedly underwent his liver transplant in Tennessee. Most patients don't travel for their surgery.
Cohen says the nonprofit United Network for Organ Sharing (UNOS), which administers the U.S. organ procurement and transplantation network, recommends getting on the waiting list at transplant centers in more than one region of the country in order to better the odds of getting a transplant sooner rather than later.
For example, Cohen says the national average wait time for a liver is 11.7 months, compared to 2.7 months where he works.
But Cohen says getting on waiting lists in other parts of the country is financially and physically draining for many patients, because they would have to get a referral and go to those centers for an evaluation.
Life After Liver Transplant
After a liver transplant, patients typically stay in the hospital for a week or two and are back to normal activities within three to four months.
Those patients must take immune-suppressing drugs for the rest of their lives, but that shouldn't limit their lives, say Cohen and Humar.
"After transplant, when they're on immunosuppressive drugs, we aim for people to lead active, normal, healthy lives," Cohen says. "There are thousands of people across the country leading very normal lives that are on some form of immune-suppression medication," Humar says.
Taking immune-suppressing drugs means an increased risk of cancer, so patients are monitored with lab tests and scans.
"The monitoring tends to be more intensive early post-transplant," Humar says. "The first few months, they may be looking at lab tests two to three times a week and maybe scans every three months. Once they get beyond a few years, then the lab testing and the scanning will become less frequent."
SOURCES: The Wall Street Journal. WebMD Health News: "Steve Jobs' Hormonal Imbalance: FAQ." WebMD Health News: "Steve Jobs Taking Medical Leave From Apple." Abhi Humar, MD, clinical director, Thomas E. Starzl Transplantation Institute; chief, division of transplantation, surgery department, University of Pittsburgh Medical Center. Ari Cohen, MD, liver transplant surgeon, Oschner Clinic Foundation, New Orleans.
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