Liver transplants like Jobs' can lead to problems

Although Steve Jobs didn't give a reason for his latest medical leave, the chief executive of Apple Inc. faces continuing health risks and potential complications from his liver transplant two years ago.

The surgery can result in "countless" difficulties afterward as patients undergo drug treatment and face possible organ rejection, said Linda Sher, a physician at the University of Southern California Liver Transplant Program in Los Angeles.

Jobs also was treated for a neuroendocrine tumor. That cancer is known to recur and can spread to the liver, said Dr. John Fung, chairman of the Digestive Disease Institute at the Cleveland Clinic in Ohio.

Neuroendocrine tumors strike about 3,000 Americans a year. This type of malignancy grows and spreads slowly, and in some patients, migrating tumors aren't detected until years after the disease is detected, Fung said.

Sometimes, patients undergo a liver transplant to stop neuroendocrine tumors from spreading, he said. Jobs hasn't given a reason for the liver transplant he had in 2009. Jobs, in a 2004 statement, indicated his neuroendocrine tumor was caught and removed. About half of patients who undergo a transplant to treat neuroendocrine malignancies have a recurrence, Fung said.

"That would be the major concern," he said Monday. "It wouldn't be a total surprise."

Both Fung and Sher said they haven't treated Jobs and don't know the details of his case.

Liver transplant complications can occur long after surgery and can take a number of forms, Sher said.

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

Transplant patients must also take drugs to prevent the immune system from attacking and rejecting the new organ, according to Sher. Because they dampen the body's disease-fighting systems, the drugs most commonly used - cyclosporine and tacrolimus - are associated with infections, tumors and kidney damage. 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 afterward, Sher said.

This article appeared on page A - 12 of the San Francisco Chronicle