A host of potential complications could explain Apple CEO Steve Jobs's newly announced medical leave of absence. The health of the 55-year-old tech executive has seemed tenuous to many observers since his previous liver transplant and bout with pancreatic cancer, and some doctors are speculating that medications could be contributing to his ailments.

Jobs's liver transplant, reportedly completed in March 2009 at a Memphis, Tenn., hospital, seemed at the time to be successful. Liver transplants, although relatively common, come with a host of potential long-term health risks and complications, including troubles caused by the immunosuppressant drugs that patients often have to take to prevent their bodies from rejecting the organ.

Liver transplants can be used to help combat islet cell neuroendocrine tumors—the rare but often treatable form of pancreatic cancer that Jobs was diagnosed with—if the cancer has spread only to the liver. Because the number of pancreatic cancer patients who fit the liver transplant profile is so small, data have been scant on the success of this procedure in fending off recurrence. A 2010 review paper reported that with a liver transplant five-year survival rates in neuroendocrine tumors range from 36 percent to 80 percent depending on the study. But a small 2007 study found that only 20 percent of patients who had had a liver and multivisceral transplantation were still disease-free after five years.

Jobs's tumor was surgically removed in July 2004. On January 5, 2009, he announced that he was being treated for a hormone imbalance, and starting January 14 of that year he took a medical leave of absence. He returned to work in June 2009.

During Jobs's current absence he will remain "involved in major strategic decisions," but his day-to-day duties will be handled by the company's chief operating officer, Tim Cook, according to a release from the company. The leave's duration is unspecified, and spokespeople for Apple declined to provide additional information about its length or the reasons for it. "I love Apple so much and hope to be back as soon as I can," Jobs wrote in Monday's message. Apple stock has dropped slightly in the wake of the announcement.

Is Steve Jobs likely to be able to get back on the job soon? Scientific American spoke with the director of University of Chicago Medical Center Transplant Center, J. Michael Millis about the ways Jobs's liver surgery and cancer diagnosis might currently be affecting the Apple executive's health.


[An edited transcript of the interview follows.]


Given what has been reported about Steve Jobs's previous liver transplant and his treatment for pancreatic cancer, what might explain why he has taken another medical leave from Apple?
Of course we know nothing about his current health—so it could be absolutely fine. We really don't have much information.

What are some of the more common complications for a liver transplant patient?
I can only speak in general about what a liver transplant patient may experience. They can develop any number of complications after their transplant: a narrowing of the bile duct where it connects the liver to the recipient, and that can cause problems. Any of the blood vessels can get a narrowing, or stenosis, that can cause problems, so those are the anatomic potential complications.

And there are metabolic complications; with the immunosuppressants, the recipients can develop hypertension, hypoglycemia and hyperlipidemia. There are the physiologic complications, such as renal dysfunction. Then there are the immunologic complications that could be over-immunosuppression or under-immunosuppression. Under-immunosuppression can lead to organ rejection, which is almost always treatable. If it's over-immunosuppression, viral infection would be the most common result.

There are also malignant complications, which in his case could be a recurrence of his tumor that he was treated for. It could also be a new tumor. Patients under immunosuppression have a tendency to develop more tumors. There's a specific type of tumor from post-transplant lymphoproliferative disorder, or PTLD, and the first treatment for that is a decrease or limitation of immunosuppressants.

Those are 90 percent of possible complications of a liver transplant. I have no clue if Steve Jobs has any of these.

9 Comments

1. 1. letxequalx 08:58 AM 1/19/11

   
   Since when is liver transplant listed among the treatments for pancreatic cancer? Pancreatic cancer is usually fatal. Obviously we are dealing with a special set of circumstances here the outcome of which will unfold over time.

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2. 2. raistlinmolina 10:06 AM 1/19/11

   It's not clear whether some people are rejected for not being S. Jobs but it's clear that Jobs got the liver for being Steve Jobs.

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3. 3. BillMcGee in reply to letxequalx 02:18 PM 1/19/11

   When what you have is an insulinoma neuroendocrine tumor that is only metastatic in the liver. Did you read the article?

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4. 4. BillMcGee in reply to raistlinmolina 02:24 PM 1/19/11

   Really? Were you monitoring the liver transplant lists and noticed that Jobs skipped to the head of the line? His transplant biology was put into a database and matched with potential owners. That's how it works. Perhaps he got into the express lane and took a liver that should have gone to some orphan child living in some impoverished circumstances, or had a Chinese liver shipped over in a cooler while iPads crossed palms at the port of entry, but those scenarios seem unlikely

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5. 5. Bruce Voigt 02:31 PM 1/19/11

   Steve Job really, really, "really" needs a Magee
   
   Magna Field Technology (magic magee healing device with its six inch body penitration) has been borrowed to produce the likes of Cold Laser Therapy (two inch penitration) the Q-Ray Bracelet (one centimeter penitration).
   google (canada) -- cbc.ca bruce voigt

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6. 6. DrPaj 02:50 PM 1/19/11

   Wish I had a nickel for every uninformed,opinion-driven response,(to medical articles), that I read online.
   I could then stop practicing medicine.
   ;)
   
   
   
   
   

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7. 7. jimfromcanada 11:32 PM 1/19/11

   I wish Mr Jobs well, and a full recovery from whatever is aiing him.

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8. 8. ironjustice 10:03 AM 1/20/11

   One might wonder if 'everything' is related as opposed to one 'causing' the OTHER or "complications arising FROM" .. ?
   Liver transplants are very commonly required by those with excess iron. Cancer is closely related to excess iron so much so that they have iron binding cancer drugs. They have recently shown while conducting a vascular study that those men who did not eat a high iron diet were signficantly less likely to GET cancer. His "medical leave" could be simply his slow decline from his initial problem which most likely has not been treated which is his excess iron. His 'tan' gives him away too. Imho.
   "direct hepatocarcinogenic effect of free iron is mediated by the generation of oxygen reactive species and oxidative damage that are mutagenic and carcinogenic"
   "Iron chelation new therapeutic approach for hepatocellular carcinoma"
   "Desferoxamine (DFO)--mediated iron chelation: rationale for a novel approach to therapy for brain cancer."
   
   "Several clinical studies have shown it to have
   antitumor activity in the treatment of neuroblastoma,
   leukemia, bladder carcinoma, and hepatocellular carcinoma."

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9. 9. ironjustice 10:11 AM 1/20/11

   Quote: Steve Job really, really, "really" needs a Magee
   Answer: Another that I've read about is a chamber which you sit / lie in which is a certain temperature. This high constant temperature raises the body into a 'fever state' and this kills the cancer. It seems to be getting some press and is backed by medical studies that I've been watching over the years. The 'mode of operation' may be the fact they've shown iron to be closely involved in cancer and by injecting iron into the person the iron gravitates to the tumor and NOW they heat it to a temperature and kill the tumor. Now if a person were to KNOW that iron IS 'already there' like has been shown .. then .. WHY wouldn't simple heating of the whole body not simply DO what the doctors are doing with the injection of the iron ?
   "Whole-body hyperthermia is used to treat metastatic cancer that has spread"
   

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