On February 15, 2002 in one of the most amazing feats of courage and athleticism, Chris Klug of the United States placed third in the Giant Slalom of Snowboarding at the Olympic Games in Salt Lake City — eighteen months after receiving someone else’s liver to replace his liver that was destroyed by a disease called primary sclerosing cholangitis. He is the first and only transplantee to compete in the Olympics.

Why a Transplanted Liver is Not as Good as Your Own Liver
When you receive someone else’s body parts, your immunity treats the transplant as an invading germ and tries to kill it. When a germ gets into your body, your white blood cells attach to it and try to destroy it. You produce chemicals that dissolve the outer membranes of the bacteria and proteins attach to the germ and kill it. The same thing happens to a transplanted liver. You must take drugs to keep your body from killing the liver.

To keep his body from rejecting the liver transplant, Chris Klug had to take prednisone, a drug that suppresses immunity to keep it from killing the transplant. I will explain more about how prednisone affects athletic performance, but first let me tell you about one of the most competitive athletes ever.

An Amazing Athlete
Chris Klug was born November 18, 1972. He started skateboarding on snow when he was 10 and was one of the pioneers of the sport. He was one of the best high school quarterbacks in his state. He turned down college football scholarships because he wanted to train for skateboarding. In 1998, he was good enough to make the United States Olympic team that competed in Nagano, Japan. He placed sixth in the giant slalom.

Primary Sclerosing Cholangitis
In his early 20s, he went to his doctor because he wasn’t feeling well. His liver tests were abnormal and the doctor could not find any explanation. 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 biopsy of his liver.

Your liver is supposed to remove breakdown products of metabolism from your bloodstream and concentrate them into liquid called bile, which travels 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.

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 the bile could not pass to the gall bladder to go into his intestines. The retained bile will eventually destroy the liver. This condition is called primary sclerosing cholangitis, and the only available treatment is a liver transplant.

Walter Payton Also Had Primary Sclerosing Cholangitis
Klug knew that his hero, Walter Payton, the great running back for the Chicago Bears Football Team, had primary sclerosing cholangitis. He also knew that in 1999, Payton died at age 45 of bile duct cancer. “I was driving to Salt Lake City for a snowboarding testing camp and listening to National Public Radio, and heard that Walter Payton had passed away. 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 soon. “I tried to work out as much as I could, but each week I got sicker and sicker.” Eighteen months before the 2002 Olympics, his doctors called him and told him that a 13-year-old boy had been killed in an accidental shooting and he could have his liver. He had been on a waiting list for a new liver for almost six years.

After Transplant Surgery
“After I woke up from that six-hour surgery, I felt like a new engine got dropped in me, it seemed like I was running around with a four-cylinder and I got a brand new V8 dropped into me, and I wanted to go out and test-drive that new engine right away. I remember being wheeled out of the surgery. And, when I finally woke up, I was at the recovery floor there, and I had both arms in the air, yelling, “I rule.” And it was a bizarre thing to say, but that’s how I felt. You know, I knew I was going to make it back.”

He left the hospital four days after receiving his liver transplant, and was back on a snowboard 49 days later. He finished third in the 2002 Olympics in Salt Lake City, and seventh in the Men’s Parallel Giant Slalom in the 2010 Olympics in Vancouver.

Prednisone Helps and Harms
Prednisone, the drug that most people take after receiving transplants to prevent their immunity from destroying the transplant, can cause serious side effects. It increases risk for diabetes, infections, stomach ulcers, osteoporosis, and mood changes. However, it can also give an athlete greater strength and endurance.

The limiting factor to how fast you can move in athletic competition is the time it takes to move oxygen into muscles. Your muscles use sugar and fat, and small amounts of protein for energy. However, sugar requires less oxygen to produce energy than fat does. Anything that helps muscles to burn more sugar and less fat will help you to move faster in athletic competition. You have an almost infinite amount of fat in your body, but you have only a very limited amount of sugar stored in your muscles and liver. Raising blood sugar levels helps muscles to burn more sugar for energy and therefore requires less oxygen.

Since prednisone raises blood sugar levels, it helps the muscles of athletes to burn a greater percentage of sugar. This helps them to contract faster and with more force. Because raising blood sugar levels gives an athlete an unfair advantage over athletes with lower blood sugar levels, The International Olympic Committee now has rule S9, “Glucocorticosteroids: All glucocorticosteroids (including prednisone) are prohibited when administered by oral, intravenous, intramuscular or rectal routes.”