Reports: Apple CEO Steve Jobs Had Liver Transplant

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 Jun 20, 2009 4:03 pm US/Mountain
Reports: Apple CEO Steve Jobs Had Liver Transplant
CANDICE CHOI, AP Business Writer
NEW YORK (AP) ―

Apple Inc. co-founder and CEO Steve Jobs, whose recovery from pancreatic cancer appeared less certain when he had to take medical leave in January, received a liver transplant two months ago but is recovering well, The Wall Street Journal reported Saturday.

The newspaper didn't reveal a source for the report, which comes as Jobs, 54, is expected back in his day-to-day duties at the company shortly. CNBC said later that it had confirmed the Journal's account, which said Jobs had the transplant performed in Tennessee.

Apple spokesman Steve Dowling told The Associated Press he had no comment. Dowling reiterated what has become Apple's standard line about the CEO's health, that "Steve continues to look forward to returning to Apple at the end of June and there is nothing further to say."

The Journal reported that at least some Apple directors were aware of the surgery.

Few CEOs are considered as instrumental to their companies as Jobs has been to Apple since he returned in 1997 after a 12-year hiatus. With Jobs serving as head showman and demanding elegance in product design, Apple has expanded from a niche computer maker to become the dominant producer of portable music players and a huge player in the cell phone business. News and rumors about his health send Apple stock soaring or plunging.

Jobs disclosed in August 2004 that he had been diagnosed with — and cured of — a rare form of pancreatic cancer called an islet cell neuroendocrine tumor.

According to the National Institutes of Health, treatment for that form of pancreatic cancer can include the removal of a portion of the liver if the cancer spreads. The cancer is curable if the tumors are removed before they spread to other organs.

It's likely that Jobs had part or all of his pancreas removed to "cure" his cancer in 2004, said Dr. Lewis Teperman, vice chair of surgery and director of transplantation at NYU Langone Medical Center in New York City.

Patients who have part or all of their pancreas removed usually get diabetes, which is treated with medication. Patients often lose weight as a result as well.

After the pancreas, the liver is the "next stop" for a tumor since blood drains from the one organ to the other, said Teperman, who did not treat Jobs.

Since the type of pancreatic cancer Jobs had is "slow growing," it's likely microscopic cells went undetected and traveled to the liver, Teperman said. Tumors often "stop" at the liver, he said, although it's possible they can spread beyond it.

The risk for liver cancer patients who get transplants is that the cancer will return in the new liver.

This can happen if undetected cancer cells are hiding out elsewhere in the body, Teperman said. He said there's no way to predict the likelihood of this occurring without knowing the extent of the initial cancer.

The five-year survival rate for organ transplants is around 75 percent, but falls among older recipients, according to the United Network for Organ Sharing, which manages transplants in the U.S.

Transplant patients must take medications for the rest of their lives to prevent rejection.

Since there is no residency requirement for transplants, Jobs might have traveled to Tennessee to shorten his wait for a liver. According to the organ network, there were 295 newly listed patients in Tennessee last year and 1,615 in California.

Wait times for transplants depend on the urgency of the patient's condition. Those in most critical need generally get transplanted within 10 days regardless of geography, said Joel Newman, a UNOS spokesman.

For less urgent cases, however, he said there's a greater variance in wait times, depending on a person's location.

Shorter waiting lists aren't the only reason to travel for a transplant, however.

"A lot of people who travel for a transplant will look at the center's survival rate or whether it specializes in certain conditions," Newman said.

Jobs' gaunt appearance last year fueled speculation that his health was worsening.

On Jan. 5 of this year, he said he had a treatable hormone imbalance and that he would continue to run the company. The following week, however, Jobs went on leave and said his medical problems were "more complex" than he had thought. Apple's chief operating officer, Tim Cook, took over daily duties.

Speculation about Jobs' health has been fueled by the Cupertino, Calif.-based company's practice of keeping such information under wraps.

Apple waited until after Jobs underwent his cancer surgery in 2004 before alerting investors. Last summer, the company insisted his thinner appearance was due to a common bug.

After Apple announced Jobs' medical leave in January, the company's shares slid 7 percent to $79.15, near a 52-week low. Since then, however, as Apple's business has remained sturdy even in the recession, and investors have become comfortable with Cook leading the daily operations, Apple shares have been among the best performers in the technology sector. The stock closed Friday at $139.48.

Jobs earned his status as a computing pioneer in 1976, when he and Steve Wozniak founded Apple in the Silicon Valley garage of Jobs' parents. Their first product, the Apple I, was a computer for hobbyists — it lacked a keyboard or monitor. But the next year they produced the Apple II for everyday consumers, and the personal-computer era was born.

 Jun 20, 2009 4:03 pm US/Mountain
Reports: Apple CEO Steve Jobs Had Liver Transplant
CANDICE CHOI, AP Business Writer
NEW YORK (AP) ―

Apple Inc. co-founder and CEO Steve Jobs, whose recovery from pancreatic cancer appeared less certain when he had to take medical leave in January, received a liver transplant two months ago but is recovering well, The Wall Street Journal reported Saturday.

The newspaper didn't reveal a source for the report, which comes as Jobs, 54, is expected back in his day-to-day duties at the company shortly. CNBC said later that it had confirmed the Journal's account, which said Jobs had the transplant performed in Tennessee.

Apple spokesman Steve Dowling told The Associated Press he had no comment. Dowling reiterated what has become Apple's standard line about the CEO's health, that "Steve continues to look forward to returning to Apple at the end of June and there is nothing further to say."

The Journal reported that at least some Apple directors were aware of the surgery.

Few CEOs are considered as instrumental to their companies as Jobs has been to Apple since he returned in 1997 after a 12-year hiatus. With Jobs serving as head showman and demanding elegance in product design, Apple has expanded from a niche computer maker to become the dominant producer of portable music players and a huge player in the cell phone business. News and rumors about his health send Apple stock soaring or plunging.

Jobs disclosed in August 2004 that he had been diagnosed with — and cured of — a rare form of pancreatic cancer called an islet cell neuroendocrine tumor.

According to the National Institutes of Health, treatment for that form of pancreatic cancer can include the removal of a portion of the liver if the cancer spreads. The cancer is curable if the tumors are removed before they spread to other organs.

It's likely that Jobs had part or all of his pancreas removed to "cure" his cancer in 2004, said Dr. Lewis Teperman, vice chair of surgery and director of transplantation at NYU Langone Medical Center in New York City.

Patients who have part or all of their pancreas removed usually get diabetes, which is treated with medication. Patients often lose weight as a result as well.

After the pancreas, the liver is the "next stop" for a tumor since blood drains from the one organ to the other, said Teperman, who did not treat Jobs.

Since the type of pancreatic cancer Jobs had is "slow growing," it's likely microscopic cells went undetected and traveled to the liver, Teperman said. Tumors often "stop" at the liver, he said, although it's possible they can spread beyond it.

The risk for liver cancer patients who get transplants is that the cancer will return in the new liver.

This can happen if undetected cancer cells are hiding out elsewhere in the body, Teperman said. He said there's no way to predict the likelihood of this occurring without knowing the extent of the initial cancer.

The five-year survival rate for organ transplants is around 75 percent, but falls among older recipients, according to the United Network for Organ Sharing, which manages transplants in the U.S.

Transplant patients must take medications for the rest of their lives to prevent rejection.

Since there is no residency requirement for transplants, Jobs might have traveled to Tennessee to shorten his wait for a liver. According to the organ network, there were 295 newly listed patients in Tennessee last year and 1,615 in California.

Wait times for transplants depend on the urgency of the patient's condition. Those in most critical need generally get transplanted within 10 days regardless of geography, said Joel Newman, a UNOS spokesman.

For less urgent cases, however, he said there's a greater variance in wait times, depending on a person's location.

Shorter waiting lists aren't the only reason to travel for a transplant, however.

"A lot of people who travel for a transplant will look at the center's survival rate or whether it specializes in certain conditions," Newman said.

Jobs' gaunt appearance last year fueled speculation that his health was worsening.

On Jan. 5 of this year, he said he had a treatable hormone imbalance and that he would continue to run the company. The following week, however, Jobs went on leave and said his medical problems were "more complex" than he had thought. Apple's chief operating officer, Tim Cook, took over daily duties.

Speculation about Jobs' health has been fueled by the Cupertino, Calif.-based company's practice of keeping such information under wraps.

Apple waited until after Jobs underwent his cancer surgery in 2004 before alerting investors. Last summer, the company insisted his thinner appearance was due to a common bug.

After Apple announced Jobs' medical leave in January, the company's shares slid 7 percent to $79.15, near a 52-week low. Since then, however, as Apple's business has remained sturdy even in the recession, and investors have become comfortable with Cook leading the daily operations, Apple shares have been among the best performers in the technology sector. The stock closed Friday at $139.48.

Jobs earned his status as a computing pioneer in 1976, when he and Steve Wozniak founded Apple in the Silicon Valley garage of Jobs' parents. Their first product, the Apple I, was a computer for hobbyists — it lacked a keyboard or monitor. But the next year they produced the Apple II for everyday consumers, and the personal-computer era was born.

http://cbs4denver.com/wireapbusiness/Reports.say.Apple.2.1052740.html

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More info explaining how Jobs was able to get a transplant when most pancreatic cancer patients would not qualify.

Jobs’s Tumor Is Rare Reason for Liver Transplant, Doctors Say

By John Lauerman

June 22 (Bloomberg) -- Steve Jobs, Apple Inc.’s chief executive officer, had one of the few types of pancreatic cancers that may be controlled by a liver transplant, doctors said.

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. Jobs’s 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. “It’s the most common place where they metastasize, and for that reason it’s 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 hasn’t disclosed the exact nature of Jobs’s medical condition. Jobs didn’t respond to an e- mail seeking comment. Apple’s lead directors, Intuit Inc. Chairman Bill Campbell and Genentech Inc. Chairman Art Levinson, didn’t 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 Foundation’s 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 haven’t spread beyond the organ. The foundation’s site doesn’t 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 aren’t being filtered from the blood, and may show swelling in the abdomen, they said.

Liver Function

The Apple executive’s outward appearance before the transplant hints that “he didn’t 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 don’t 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.

While most patients with pancreatic cancer live less than a year after diagnosis, the islet-cell form found in Jobs grows slowly and can be treated with surgery to remove the tumor, Lo said.

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 Sinai’s Lo. Klug had needed a new liver because of a rare degenerative condition of the bile duct.

“It’s a pretty standard procedure now,” Lo said June 20 in a telephone interview. “Just about every major medical center has a program.”

While the first two to three weeks after the surgery can be “hairy,” as doctors watch for infections and signs of organ rejection, patients typically do well after they’ve gone home, said Lo. Patients take drugs to prevent organ rejection for the rest of their lives after transplants, he said.

“Many go for years without any problems,” Lo said. “You can be physically normal, you can even be physically competitive, after having a liver transplant.”

Recovery Time

Most are back at work in about two to three months, Humar said. All patients have to take at least one immune-system suppressing drug to prevent rejection, and doctors carefully set doses to minimize the chances that patients get infections or develop other cancers, he said.

The source of Jobs’s donor organ and the hospital where the transplant was performed aren’t public. About 17,000 patients are awaiting liver transplants in the U.S., according to the American Liver Foundation. Available organs are carefully doled out to the sickest patients, and many who need organs may have to wait years to qualify, Humar said.

Because the liver can regenerate itself, people who need transplants can receive partial organs from living donors, Humar said. Both the remaining partial organs, in the donor and recipient, grow back to normal size after the surgery.

“If you have a donor for yourself, you don’t have to be in the waiting queue,” Humar said. “If your brother gives you half a liver, you can do the transplant as soon as you’re ready. You could do it tomorrow.”

To contact the reporters on this story: John Lauerman in Boston at rgale5@bloomberg.net.
Last Updated: June 22, 2009 01:00 EDT

http://www.bloomberg.com/apps/news?pid=20601205&sid=ax_6mEPxzi3I#