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06-22-2009, 07:58 AM #21
A message to Steve:
All the best to you and may you have a full recovery. You have been a singular innovator responsible for the success of Apple and some insanely great products that have benefited many. For selfish reasons, I hope you will come back to Apple and continue your amazing work, but do whatever is best for you.
06-22-2009, 12:19 PM #22
It's the non-sense opinions from undocumented bloggers regarding money and its ability to buy you a better position to get a liver transplant, or that the transplant happened despite pancreatic cancer (misleading/false) what creates an inflammatory atmosphere, to say the least.
06-22-2009, 05:38 PM #23
EVERY patient waiting for an organ transplant in the United States is registered in the UNOS (United Network of Organ Sharing) computerized data network. This is a national network that matches organs with recipients based on genetic suitability and severity of illness. No ONE hospital gets preference over another, regardless if they have 20 livers sitting in the O.R. and only one liver transplant candidate. All candidates have equal access to donated organs, theoretically.
However if you are in the position of making a sizeable donation to the UNOS system (cough...Mickey Mantle...cough...cough Steve Jobs)....well lets just say, money talks. No one will admit to that, but it still is a fact of life that the privileged are....well......privileged
and BTW Steve Jobs DID have pancreatic cancer, not the most aggressive kind, but any kind of pancreatic cancer is bad b/c there is usually an abscence of symptoms until late in the course of the disease. Most likely this IS metastatic liver cancer. And THAT IS a relative contraindication to liver transplant. Especially withe the shortage of organs. There have been around 100 transplants for this type of pancreatic tumor. (neuroendocrine islet cell tumor) , usually done for symptomatic relief. The long-term survival is not great however.
So please stop berating people, when you don't have the correct information.
Last edited by jot9011; 06-22-2009 at 06:31 PM.
06-22-2009, 11:13 PM #24
I once prayed to God for an iPhone, but quickly found out He didn't work that way...so I stole an iPhone and prayed for His forgiveness.
A dog is the only thing on earth that loves you more than you love yourself. - Josh Billings
06-24-2009, 01:04 AM #25
1.- True that anybody awaiting an organ for transplantation in this country is listed in UNOS. But matching organs according to "genetic suitability"??!! (Ouch!!). That's a nice one! It is not true, however, that all the organs get allocated according to the severity of illness, although for livers, in the current (MELD) system, the severity of illness does play an important role.
2.- A hospital can get preference, if it is the only one within an OPO (organ procurement organization) coverage area in which the allocation is first by OPO, then by State, then by UNOS Region, and then finally National. As an example, if you live to the west of the Hudson river, in NJ, you can get a liver with a much, much lower MELD (thus healthier) than if you live just across the bridge, in NY. Granted that you can get listed in both places, but many insurance companies will not pay for your care if you chose to go out-of-state, or out-of-region, making it really impossible for you to get to those organs (unless you pay out of pocket).
3.- When Mickey Mantle got his liver transplant, the organ allocation system was completely different to the one we have today, and was geared basically by waiting time, not severity of disease. And even though a lot of progress has been made since, his case helped to create a largely negative cloud of perception regarding the fairness of access to liver transplantation, that perdures to this date (e.g.: just judging from what has been written in this forum so far). And, by the way, I don't consider poor Mickey Mantle a privileged.
4.- This is NOT metastatic liver cancer, but metastatic neuroendocrine tumor (mNET) to the liver; Big difference!. This is not the same as the commonly known pancreatic cancer, which refers to any variant of pancreatic adenocarcinoma. This last one is, indeed, an ABSOLUTE (not "relative") contraindication for liver transplantation. To this date, mNET is, in fact, an approved medical indication to treat well selected (and that is medically selected, not economically selected) cases.
5.- Only 100 cases done??!! Now that's free talking! Just a French series published a year ago in the American Journal of Transplantation quoted 85 cases of liver transplantation for mNET. If you add that to the previously reported series, you add over 350 cases (an those are just the published ones). And the results are, contrary to what you say, BETTER than for other indications. Again, not free talking, but facts: the current 1-year patient survival in the USA for liver transplantation (all comers) is 88 %, which compares poorly with the last series published from Milan in July of 2007, in which out of 24 patients transplanted for mNET, the 5-year survival was 90%. Now, how is that not great result?
6.- Finally, THESE ARE LIVER TRANSPLANTS, not aspirins!!! You don't transplant a liver for "symptomatic relief" (or maybe you do, which explains all that non-sense in your message.)
So please, read through, and read again, and when you think you know the right answers, come back and even you can take the test again.
Last edited by chanquete; 06-24-2009 at 01:15 AM.
06-24-2009, 10:56 AM #26
You obviously know how to use the internet to find information, but your knowledge gaps are quite transparent.
1.) If organs are not HLA matched...(that's a genetic trait professor). then please explain, with your vast understanding of medicine, how organs are matched to recipients? Just to save you some googling time the answer is: To reduce the risk of rejection in the recipient HLA matching is done. There is still a debate whether HLA-matching has changed the outcome of organ rejection, but I don't know any Transplant surgeon who doesn't do it.
2.) I do understand that the primary cancer was pancreatic. "Metastatic (to)liver cancer" was used to differentiate it from primary hepatocellular carcinoma. Metastatic cancer IS an absolute contraindication for liver transplant except in cases such as these. You seem to want to argue semantics.
3.) Most patients with this type of cancer unfortunately present with a locally advanced or metastatic disease. For patients with an advanced functioning NET, control of the hormonal syndrome may also represent a surgical indication. So you see RELIEF of SYMPTOMS that are unresponsive to medical therapies is an indication for transplant. (You might want to deepen your Google search on that one)
4.) Different series report differing 5-year survival. This study: Am J Transplant. 2008 Jun;8(6):1205-13. Epub 2008 Apr 29. reported 12% 5-year survival rate. But a 20-30% 5-year disease-free survival for metastatic MET is commonly reported.
There is a difference between survival and disease-free survival (cure) which is about 20% at 5 years. ( Liver Transpl. 2007 Mar;13(3):327-33.Links Orthotopic liver or multivisceral transplantation as treatment of metastatic neuroendocrine tumors.)
My quote of 100 cases was a bit shy. I was estimating. OLT for NET still only represents a very small proportion of the total # of transplants done. You cannot compare all-comers to this sub-set of patients.
I included a few references because I didn't want you to think I was "free-talking"
Care to try again professor?
06-24-2009, 02:10 PM #27
So.... how 'bout them Mets?
06-24-2009, 11:15 PM #28
1.- Livers are NEVER HLA matched. Hearts are, and kidney are too. But for livers, a compatible blood type (and some times, not even that) and a relative size match is all you need. So you must know a lot of kidney transplant surgeons, but not liver transplant surgeons.
2.- Your goof, so no comment.
3.- Surgical indication for resection only, not transplant. You transplant with the intent to cure, not to stop the symptoms.
4.- The Mazzaferro series from Milan, which seems to be the most recent and formal approach to these tumors, still quotes a DFS of 77% at 5 years.
And yes, when you want to say that the results are not that good in OLT for NET, you have to compare to the whole group of OLT patients, and see who fares better. Obviously, if you compare them with a group of patients that had dental extractions, I'm pretty sure that the dental extraction group had a better survival.
Nevertheless, now I understand. A subtle clue gave you up, and that explains a lot of what has been written in these (OLT) forum for the last couple of days. And that's also why I'm stopping right here.
Stay well, and keep trying...
Last edited by chanquete; 06-24-2009 at 11:19 PM.
06-25-2009, 07:34 AM #29
You are still quite mis-informed. There is a much larger tomb of knowledge on this subject outside of your Google search engine.
06-25-2009, 08:17 AM #30
WHy don't you two take your discussion to ModMyLiver.com?
06-25-2009, 08:40 AM #31
06-25-2009, 12:03 PM #32
06-25-2009, 12:32 PM #33
Thank you, Mr. 8 Posts, for your valuable information provided. Although you have been a member of this forum since August 2007, 4 of your grand total of 8 posts have been in this thread, and have absolutely nothing to do with the iPhone. Your contributions to this community are most noteworthy.
Although the topic of this thread is indeed the liver transplant surgery that Mr. Jobs had, it was posted, I am certain, due to the interest of Mt. Jobs' health as it relates to the Mac community. His welfare, many believe, has a direct implication on the success of Apple.
However, the detail of medical information about liver transplants, as well as the argumentative tone between the two of you, has absolutely nothing at all to do with the iPhone, or the scope of this forum. This web site is ModMyI - meaning it is a place for discussion of things related to the modification and use of the iPhone. it is not a forum of the New England Journal of Medical Science.
A few semi-humorous posts in this thread have been placed to attempt to lighten things up, but instead, there has been a continual in-depth argumentative medical discussion, not really relating to Mr. Jobs, but to the overall situation regarding liver transplants.
Liver transplant is quite obviously a thing of great concern to you. You are passionate about it. Nothing wrong with that. It is simply out of place in a forum about the use of the iPhone - even within the context of a posting about the news of Mr. Jobs' surgery.
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06-25-2009, 01:25 PM #34
06-29-2009, 12:36 AM #35