Saturday, June 20, 2009

Steve Jobs' Reported Liver Transplantation

N.B. The post is based on publicly available sources. I have not ever personally treated Mr. Jobs and have no access to his private medical records.
Several hours ago the Wall Street Journal reported that Mr. Jobs underwent a liver transplantation approximately two months ago. This is somewhat consistent with my earlier posts about his condition, i.e. that the tumor had recurred and spread to his liver. At the time of my earlier posts I had come to understand that Mr. Jobs was not a candidate for transplantation for unspecified reasons. If the report is true, then this situation has obviously changed.
The reason for liver transplantation would be that the carcinoid tumor had spread SOLELY to his liver and that in the opinion of his physicians removal of the entire liver would be more likely to produce a cure, long term survival or improvement of overall medical condition than conventional medical treatment.
Liver transplantation becomes an option when the tumor is of a size or in a position where partial removal of the liver (the tumor containing portion) or treatment which is aimed at removing the tumor nodules only (freezing [cryoablation], heating [radio frequency ablation], hepatic artery embolization, hepatic artery chemotherapy) is failing or is not able to be performed. Contraindications (reasons against) to the transplantation would be that the tumor has spread outside the liver. The reason for this is that the treatment necessary to prevent liver rejection, immunosuppressive treatment, interferes with the body's natural ability to prevent tumor growth and therefore can cause other tumor metastases to grow. Transplantation is an accepted, but uncommon treatment for metastatic carcinod. The reason is that there is no, in the language of medical literature, prospective randomized trials (a study to compare the efficacy of transplantation vs. 'conventional' treatment where your treatment is determined by random choice) to demonstrate that this is an effective treatment. In reality due to the rarity of the condition it is unlikely that such a trial could ever be done.
That being said, if the reports are true and the transplantation is successful Mr. Jobs is highly likely to be able to return to a fully functional life style as long a he continues to comply with his physician's orders as to his treatment.

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