CHRIS KLUG, OLYMPIAN: PRIMARY SCLEROSING CHOLANGITIS

On February 15, 2002, Chris Klug of the United States placed third in the Giant slalom of Snowboarding at the Olympic Games. This is one of the the most amazing feats of courage and athleticism that has ever occurred anywhere. Eighteen months before the Olympic games, Chris Klug received someone else's liver to replace his liver damaged by a disease called primary sclerosing cholangitis. Seven weeks later, he resumed training for snowboarding, and 18 months later he was an Olympic medalist. So you say, so what, isn't a liver transplant just as good as a person's own liver? What's the fuss?

The only way that a person's immunity will accept someone else's liver and not kill it is for that person to take immune suppressant drugs. To keep his body from rejecting the liver, he must take prednisone, a drug that markedly slows recovery of muscles from hard exercise. When you train for sports, you take a hard workout which damages muscles, feel sore the next day,and then train at a low intensity until the soreness goes away. Anything that helps you recover faster makes you a better athlete because it allows you to take another hard workout sooner. For example, taking male hormones, called anabolic steroids, helps athletes recover faster than normal people who do not take steroids, so they can do more intense work and improve faster than people who don't take them.

Chris Klug takes prednisone which delays recovery from hard exercise. So he cannot work out as often or as hard as a person who does not take it. Therefore he should not be able to compete against normal people, unless he is so much better than everyone else that he can compete on less training than his competitors. And he is better than everyone else. He was the best high school quarterback in his state. He also is probably the greatest athlete in the world who takes prednisone.

He placed sixth, with his own liver, in the 1998 Olympics. Nine years ago, he had a routine physical exam and was found to have abnormal liver blood tests. Doctors could not find a reason why his liver tests were abnormal. He didn't have hepatitis B or C and he didn't have any genetic diseases, such as copper or iron poisoning, that damage the liver. So they did a liver biopsy and diagnosed primary sclerosing cholangitis (PSC).

Your liver is supposed to remove breakdown products of metabolism from your bloodstream, concentrate them into liquid called bile, which is supposed to travel along special ducts to be stored in your gall bladder. When you eat, your gall bladder contracts and pushes the bile along a tube into your intestines, where bile helps break down food into building blocks that can be absorbed into the bloodstream. But Klug's liver biopsy showed that scars blocked the ducts that carry bile through the liver. The liver continued to remove breakdown products of metabolism from his bloodstream and make bile, but bile could not pass to the gall bladder.

Klug knew that his hero, Walter Payton, the great running back for the Chicago Bears Football Team had primary sclerosing cholangitis and in 1999, died at age 45 of bile duct cancer. "I was driving to Salt Lake City for a snowboarding testing camp and listening to NPR, and heard that Walter Payton had passed away," said Klug, 29. "I pulled over and cried. I was under the impression that Primary Sclerosing Cholangitis patients didn't die, and I was scared to death. That's the first time it really hit me." In the spring of 2000, he woke up in the night with a stabbing pain. He was told that he would die if he did not get a new liver. "I tried to work out as much as I could, but each week I got sicker and sicker." He left the hospital four days after receiving his liver transplant, and was back on a snowboard seven weeks later. To keep his immunity from destroying his new liver, he takes prednisone, a drug that delays healing after hard exercise. Chris Klug won an Olympic medal with some one else's liver, while taking prednisone, a drug that prevents him from training properly. He has to be one of the greatest athletes in the world.