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Payton was too sick for transplant
Posted: Monday November 01, 1999 08:45 PM
CHICAGO (AP) -- When liver specialists watched Walter Payton announce in February he had a rare disease that would require a liver transplant to keep him alive, they suspected something else: Payton was too sick for a transplant. "I knew he had cancer," said Dr. David Van Thiel, director of the liver transplant program at Loyola University Medical Center. "I was sure he wasn't going to get a transplant because you can't transplant when they have cancer." The clue was that the Payton who spoke that day was both gaunt and jaundiced -- a sure sign Payton not only had primary sclerosing cholangitis but bile duct cancer as well. As late as the day before he died, Payton's friends and family denied the NFL career rushing leader was gravely ill and said his condition had not deteriorated enough to make him eligible for a new liver. But liver specialists said they were sure Payton was, in fact, dying. "Survival once you get this [bile duct cancer] is about 11 months," said Dr. John Brems, director of intrabdominal transplantation at Loyola. Monday afternoon, hours after Payton died, his doctors confirmed what liver specialists suspected: Besides PSC, a mysterious disease that causes the body's immune system to mistakenly attack its own tissues, Payton had cancer of the bile duct. Dr. Greg Gores, who was treating Payton at the Mayo Clinic in Rochester, Minn., said the cancer killed Payton. Gores would not say when Payton learned he had cancer. But judging by Payton's appearance, liver specialists speculated he knew of his cancer at the time he announced he would need a transplant. "My guess is he knew he wasn't going to get a transplant," said Van Thiel. Payton had a disease that scars the bile ducts, which carry bile from the liver to the small intestine to help digest food. When the ducts get blocked, bile backs up and migrates elsewhere. Van Thiel explained that PSC is characterized by acute inflammation of the bile ducts both in and outside the liver. "There is a replication of cells and sooner or later there's going to be an error in that replication and a cell is going to be an abnormal cell, a cancer cell," said Van Thiel. He said the cancer that killed Payton occurs in about 10 percent of PSC cases. Once a PSC patient has cancer, doctors say, a liver transplant is no longer an option. Doctors often call off liver transplants if they find bile duct cancer, because the drugs needed to keep the body from rejecting the new liver make tumors grow faster. "It's like adding gasoline to a fire," said Brems. "You're trying to suppress the immune system [for the new liver] and you need to stimulate immune system to fight the cancer." Sometimes doctors don't see the tumors and unwittingly transplant livers in patients with the cancer. "One out of 10 survive two years," said Brems.
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